Provider Demographics
NPI:1114064938
Name:CANANDAIGUA DENTAL HEALTH, PLLC
Entity Type:Organization
Organization Name:CANANDAIGUA DENTAL HEALTH, PLLC
Other - Org Name:V, BRAIN GAGLIARDI, DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JO ANNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAGLIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-394-5910
Mailing Address - Street 1:317 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2118
Mailing Address - Country:US
Mailing Address - Phone:585-394-5910
Mailing Address - Fax:
Practice Address - Street 1:317 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2118
Practice Address - Country:US
Practice Address - Phone:585-394-5910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045901261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY045901OtherLICENSE
NY045901OtherLICENSE