Provider Demographics
NPI:1073771739
Name:GITANGU, JOYCE S (DMD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:S
Last Name:GITANGU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ARNOLD RD
Mailing Address - Street 2:APT 34
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-3004
Mailing Address - Country:US
Mailing Address - Phone:781-475-4848
Mailing Address - Fax:
Practice Address - Street 1:2181 WASHINGTON ST
Practice Address - Street 2:101
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2082
Practice Address - Country:US
Practice Address - Phone:617-427-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice