Provider Demographics
NPI:1922285881
Name:DENNIS S GIANOLI DDS PC
Entity Type:Organization
Organization Name:DENNIS S GIANOLI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:GIANOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-828-3559
Mailing Address - Street 1:5 WEBSTER SQUARE ROAD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037
Mailing Address - Country:US
Mailing Address - Phone:860-828-3559
Mailing Address - Fax:860-828-1485
Practice Address - Street 1:5 WEBSTER SQUARE ROAD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037
Practice Address - Country:US
Practice Address - Phone:860-828-3559
Practice Address - Fax:860-828-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT49011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT23464Medicare UPIN