Provider Demographics
NPI:1164546008
Name:PATRICK L GADOLA, DDS, PC
Entity Type:Organization
Organization Name:PATRICK L GADOLA, DDS, PC
Other - Org Name:CHARLOTTE FAMILY DENTRISTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:LAURENCE
Authorized Official - Last Name:GADOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-321-8186
Mailing Address - Street 1:204 S BOSTWICK ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1801
Mailing Address - Country:US
Mailing Address - Phone:517-543-2820
Mailing Address - Fax:517-543-0297
Practice Address - Street 1:204 S BOSTWICK ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1801
Practice Address - Country:US
Practice Address - Phone:517-543-2820
Practice Address - Fax:517-543-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010156011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty