Provider Demographics
NPI:1275716458
Name:GAETA DENTAL HEALTH PROFESSIONALS, PA
Entity Type:Organization
Organization Name:GAETA DENTAL HEALTH PROFESSIONALS, PA
Other - Org Name:GAETA DENTAL - HILLVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COORD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:1865 HILLVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3606
Mailing Address - Country:US
Mailing Address - Phone:941-365-4500
Mailing Address - Fax:941-365-5788
Practice Address - Street 1:1865 HILLVIEW ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3606
Practice Address - Country:US
Practice Address - Phone:941-365-4500
Practice Address - Fax:941-365-5788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAETA DENTAL HEALTH PROFESSIONALS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty