Provider Demographics
NPI:1316169311
Name:PUCCIO, GARY THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:THOMAS
Last Name:PUCCIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:255 SCHUURMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-3223
Mailing Address - Country:US
Mailing Address - Phone:518-477-2727
Mailing Address - Fax:518-477-2728
Practice Address - Street 1:255 SCHUURMAN ROAD
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-3223
Practice Address - Country:US
Practice Address - Phone:518-477-2727
Practice Address - Fax:518-477-2728
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040724-11223X0400X
MA168531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics