Provider Demographics
NPI:1255500559
Name:PAUL J. R. GAMACHE DMD PC
Entity Type:Organization
Organization Name:PAUL J. R. GAMACHE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J R
Authorized Official - Last Name:GAMACHE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-442-8664
Mailing Address - Street 1:137 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6556
Mailing Address - Country:US
Mailing Address - Phone:413-442-8664
Mailing Address - Fax:413-442-8606
Practice Address - Street 1:137 ELM ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6556
Practice Address - Country:US
Practice Address - Phone:413-442-8664
Practice Address - Fax:413-442-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty