Provider Demographics
NPI:1639285992
Name:GAETA DENTAL OF SIESTA KEY, PLLC
Entity Type:Organization
Organization Name:GAETA DENTAL OF SIESTA KEY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JANISZEWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-486-0561
Mailing Address - Street 1:609 S. TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285
Mailing Address - Country:US
Mailing Address - Phone:941-486-0561
Mailing Address - Fax:
Practice Address - Street 1:5223 AVENIDA NAVARRA
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34242-2029
Practice Address - Country:US
Practice Address - Phone:941-349-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty