Provider Demographics
NPI:1528012812
Name:GAIDIS, PETER GAIDIS JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GAIDIS
Last Name:GAIDIS
Suffix:JR
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 1:190 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-2938
Mailing Address - Country:US
Mailing Address - Phone:856-629-4145
Mailing Address - Fax:856-262-1205
Practice Address - Street 1:989 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1011
Practice Address - Country:US
Practice Address - Phone:856-629-7806
Practice Address - Fax:856-262-1205
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI016497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist