Provider Demographics
NPI:1821477050
Name:GARY ANDREOLETTI DDS PC
Entity Type:Organization
Organization Name:GARY ANDREOLETTI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREOLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-858-4544
Mailing Address - Street 1:576 KOKOPELLI BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-6304
Mailing Address - Country:US
Mailing Address - Phone:970-858-4544
Mailing Address - Fax:970-858-9187
Practice Address - Street 1:576 KOKOPELLI BLVD
Practice Address - Street 2:STE. B
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-6304
Practice Address - Country:US
Practice Address - Phone:970-858-4544
Practice Address - Fax:970-858-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1044191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty