Provider Demographics
NPI:1356562391
Name:GAETA, JOHN J (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:GAETA
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:ONE SCHOOL STREET
Mailing Address - Street 2:SUITE #105
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-671-0817
Mailing Address - Fax:516-671-3441
Practice Address - Street 1:ONE SCHOOL STREET
Practice Address - Street 2:SUITE #105
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-671-0817
Practice Address - Fax:516-671-3441
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY343871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice