Provider Demographics
NPI:1891865655
Name:VIRGINIA E GAVRIS PC
Entity Type:Organization
Organization Name:VIRGINIA E GAVRIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-527-0880
Mailing Address - Street 1:381 ELLIOT ST
Mailing Address - Street 2:SUITE 195L
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1157
Mailing Address - Country:US
Mailing Address - Phone:617-527-0880
Mailing Address - Fax:617-964-2229
Practice Address - Street 1:381 ELLIOT ST
Practice Address - Street 2:SUITE 195L
Practice Address - City:NEWTON UPPER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02464-1157
Practice Address - Country:US
Practice Address - Phone:617-527-0880
Practice Address - Fax:617-964-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty