Provider Demographics
NPI:1487856860
Name:JUSINO, GILDA V (DENTIST DMD)
Entity Type:Individual
Prefix:MS
First Name:GILDA
Middle Name:V
Last Name:JUSINO
Suffix:
Gender:F
Credentials:DENTIST DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231
Mailing Address - Country:US
Mailing Address - Phone:716-204-5838
Mailing Address - Fax:716-632-2963
Practice Address - Street 1:1740 WALDEN AVE
Practice Address - Street 2:STE 100
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225
Practice Address - Country:US
Practice Address - Phone:716-332-3026
Practice Address - Fax:716-332-2146
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0476081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist