Provider Demographics
NPI:1912228081
Name:DENTISTRY BY NITA GAMPA, DMD, PC
Entity Type:Organization
Organization Name:DENTISTRY BY NITA GAMPA, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMPA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:774-287-2669
Mailing Address - Street 1:67 HIGHLAND ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2734
Mailing Address - Country:US
Mailing Address - Phone:508-755-9394
Mailing Address - Fax:
Practice Address - Street 1:67 HIGHLAND ST
Practice Address - Street 2:UNIT 1
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2734
Practice Address - Country:US
Practice Address - Phone:508-755-9394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty