Provider Demographics
NPI:1326181637
Name:GARGIULO, G JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:G
Middle Name:JOHN
Last Name:GARGIULO
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 1:895 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3918
Mailing Address - Country:US
Mailing Address - Phone:860-482-9481
Mailing Address - Fax:860-489-1924
Practice Address - Street 1:895 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3918
Practice Address - Country:US
Practice Address - Phone:860-482-9481
Practice Address - Fax:860-489-1924
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT 57889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2057891Medicaid