Provider Demographics
NPI:1114304490
Name:GARGANO, THEODORE (DMD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:GARGANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WASHINGTON AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2368
Mailing Address - Country:US
Mailing Address - Phone:032-390-6782
Mailing Address - Fax:203-239-3985
Practice Address - Street 1:21 WASHINGTON AVE UNIT A
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2368
Practice Address - Country:US
Practice Address - Phone:203-239-2356
Practice Address - Fax:203-239-3985
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT116791223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice