Provider Demographics
NPI:1285657635
Name:GAZITUA, EMILY GRACE (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:GRACE
Last Name:GAZITUA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1422
Mailing Address - Country:US
Mailing Address - Phone:207-862-2600
Mailing Address - Fax:207-862-2602
Practice Address - Street 1:27 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1422
Practice Address - Country:US
Practice Address - Phone:207-862-2600
Practice Address - Fax:207-862-2602
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME3378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist