Provider Demographics
NPI:1699012500
Name:ESOLDI, GARY
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:ESOLDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 HACKENSACK AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6304
Mailing Address - Country:US
Mailing Address - Phone:201-488-8228
Mailing Address - Fax:201-488-4155
Practice Address - Street 1:481 HACKENSACK AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6304
Practice Address - Country:US
Practice Address - Phone:201-488-8228
Practice Address - Fax:201-488-4155
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice