Provider Demographics
NPI:1366445850
Name:MILANESI, GARY D (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:MILANESI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-2028
Mailing Address - Country:US
Mailing Address - Phone:201-941-5955
Mailing Address - Fax:201-941-8832
Practice Address - Street 1:76 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-2028
Practice Address - Country:US
Practice Address - Phone:201-941-5955
Practice Address - Fax:201-941-8832
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ127311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice