Provider Demographics
NPI:1891979621
Name:GEOFFREY R. GAMACHE DDS PLLC
Entity Type:Organization
Organization Name:GEOFFREY R. GAMACHE DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAMACHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-674-3174
Mailing Address - Street 1:1 EASTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-2402
Mailing Address - Country:US
Mailing Address - Phone:518-674-3174
Mailing Address - Fax:518-674-3001
Practice Address - Street 1:1 EASTVIEW RD
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-2402
Practice Address - Country:US
Practice Address - Phone:518-674-3174
Practice Address - Fax:518-674-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0308481223G0001X
NY050492-11223G0001X
NY0366021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty