Provider Demographics
NPI:1154499432
Name:LOGIN, GARY RONALD (DMD, DMSC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RONALD
Last Name:LOGIN
Suffix:
Gender:M
Credentials:DMD, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 HARVARD ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5071
Mailing Address - Country:US
Mailing Address - Phone:617-277-0807
Mailing Address - Fax:617-566-5331
Practice Address - Street 1:209 HARVARD ST
Practice Address - Street 2:SUITE 402
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5071
Practice Address - Country:US
Practice Address - Phone:617-277-0807
Practice Address - Fax:617-566-5331
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice