Provider Demographics
NPI:1134421068
Name:ERNEST GAILIUNAS DMD PC
Entity type:Organization
Organization Name:ERNEST GAILIUNAS DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:GAILIUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-428-3677
Mailing Address - Street 1:10 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2518
Mailing Address - Country:US
Mailing Address - Phone:508-428-3677
Mailing Address - Fax:888-786-9764
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:COTUIT
Practice Address - State:MA
Practice Address - Zip Code:02635-2518
Practice Address - Country:US
Practice Address - Phone:508-428-3677
Practice Address - Fax:888-786-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN149501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty