Provider Demographics
NPI:1124116165
Name:GAGLIARDI, VICTOR BRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:BRIAN
Last Name:GAGLIARDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2118
Mailing Address - Country:US
Mailing Address - Phone:585-394-5910
Mailing Address - Fax:
Practice Address - Street 1:317 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2118
Practice Address - Country:US
Practice Address - Phone:585-394-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0459011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY045901OtherLIC. #
NYBG8634948OtherDEA