Provider Demographics
NPI:1245557644
Name:GINTAUTAS, STANISLAV (DDS)
Entity Type:Individual
Prefix:
First Name:STANISLAV
Middle Name:
Last Name:GINTAUTAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3629
Mailing Address - Country:US
Mailing Address - Phone:646-684-5717
Mailing Address - Fax:
Practice Address - Street 1:587 ELM ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-5113
Practice Address - Country:US
Practice Address - Phone:203-359-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0102261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice