Provider Demographics
NPI:1982881777
Name:MARK A. DELLI-GATTI, D.D.S. & ASSOCIATES
Entity Type:Organization
Organization Name:MARK A. DELLI-GATTI, D.D.S. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DELLI-GATTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-424-5002
Mailing Address - Street 1:2905 DUDLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101
Mailing Address - Country:US
Mailing Address - Phone:304-424-5002
Mailing Address - Fax:304-422-5740
Practice Address - Street 1:2905 DUDLEY AVENUE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101
Practice Address - Country:US
Practice Address - Phone:304-424-5002
Practice Address - Fax:304-422-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty