Provider Demographics
NPI:1356366165
Name:GULINO, DANTE E JR (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:DANTE
Middle Name:E
Last Name:GULINO
Suffix:JR
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 ROUTE 184
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340
Mailing Address - Country:US
Mailing Address - Phone:860-449-1023
Mailing Address - Fax:
Practice Address - Street 1:495 GOLD STAR HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6228
Practice Address - Country:US
Practice Address - Phone:860-449-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0083531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1369886OtherUNITED CONCORDIA #
CTCV5432OtherACS HEALTHNET #
CT020008353CT01OtherANTHEM PROVIDER #
CT008353OtherPROVIDER #
CT008353OtherPROVIDER #
CTBG7715850OtherDEA #
CTU74895Medicare UPIN