Provider Demographics
NPI:1760614507
Name:GAMMA DENTAL ART P.C.
Entity Type:Organization
Organization Name:GAMMA DENTAL ART P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-376-6006
Mailing Address - Street 1:1502 E 14TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7148
Mailing Address - Country:US
Mailing Address - Phone:718-376-6006
Mailing Address - Fax:718-376-7339
Practice Address - Street 1:1502 E 14TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7148
Practice Address - Country:US
Practice Address - Phone:718-376-6006
Practice Address - Fax:718-376-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02576603Medicaid