Provider Demographics
NPI:1477644664
Name:GAGE, VALENTINA CONDIO (DMD)
Entity type:Individual
Prefix:DR
First Name:VALENTINA
Middle Name:CONDIO
Last Name:GAGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:C
Other - Last Name:GAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2945 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614
Mailing Address - Country:US
Mailing Address - Phone:203-375-3068
Mailing Address - Fax:203-375-4578
Practice Address - Street 1:2945 MAIN STREET
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614
Practice Address - Country:US
Practice Address - Phone:203-375-3068
Practice Address - Fax:203-375-4578
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist