Provider Demographics
NPI:1386732790
Name:JAMES V GAGNE DMD PC
Entity type:Organization
Organization Name:JAMES V GAGNE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:508-754-9155
Mailing Address - Street 1:32 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609
Mailing Address - Country:US
Mailing Address - Phone:508-754-9155
Mailing Address - Fax:508-752-0909
Practice Address - Street 1:32 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609
Practice Address - Country:US
Practice Address - Phone:508-754-9155
Practice Address - Fax:508-752-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty