Provider Demographics
NPI:1487689790
Name:GAMACHE, PAUL J R (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J R
Last Name:GAMACHE
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 1:137 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:413-499-9276
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:413-499-9276
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist