Provider Demographics
NPI:1114183027
Name:GISONDA, ANGELA (DDS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GISONDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 BROOKVILLE LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2300
Mailing Address - Country:US
Mailing Address - Phone:516-382-2296
Mailing Address - Fax:
Practice Address - Street 1:268 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3347
Practice Address - Country:US
Practice Address - Phone:516-378-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist