Provider Demographics
NPI:1225231657
Name:GUMUCIO, REGINA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:M
Last Name:GUMUCIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3353
Mailing Address - Country:US
Mailing Address - Phone:732-634-3444
Mailing Address - Fax:732-634-7269
Practice Address - Street 1:34 GREEN ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3353
Practice Address - Country:US
Practice Address - Phone:732-634-3444
Practice Address - Fax:732-634-7269
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0152101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice