Provider Demographics
NPI:1235327628
Name:B GAIL DEMKO DMD PC
Entity Type:Organization
Organization Name:B GAIL DEMKO DMD PC
Other - Org Name:SLEEP APNEADENTISTS OF NEW ENGLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:B
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:DEMKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-964-4028
Mailing Address - Street 1:140 MERRIAM STREET
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02943
Mailing Address - Country:US
Mailing Address - Phone:617-964-4028
Mailing Address - Fax:617-595-4591
Practice Address - Street 1:140 MERRIAM ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1319
Practice Address - Country:US
Practice Address - Phone:617-964-4028
Practice Address - Fax:617-595-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14113122300000X
MI290101 3651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11444OtherBCBS
MA6491640001Medicare PIN