Provider Demographics
NPI:1225740988
Name:GAETAN D. CHARBONNEAU, DMD, LTD
Entity Type:Organization
Organization Name:GAETAN D. CHARBONNEAU, DMD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARBONNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-783-4223
Mailing Address - Street 1:24 SALT POND RD STE A2
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4304
Mailing Address - Country:US
Mailing Address - Phone:401-783-4223
Mailing Address - Fax:401-783-1228
Practice Address - Street 1:24 SALT POND RD STE A2
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4304
Practice Address - Country:US
Practice Address - Phone:401-783-4223
Practice Address - Fax:401-783-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty