Provider Demographics
NPI:1992927669
Name:GEORGE GAILLARDETZ DMD, INC
Entity type:Organization
Organization Name:GEORGE GAILLARDETZ DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ARMAND
Authorized Official - Last Name:GAILLARDETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-569-2268
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03896-0998
Mailing Address - Country:US
Mailing Address - Phone:603-569-2268
Mailing Address - Fax:603-569-5837
Practice Address - Street 1:26 BAY ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4320
Practice Address - Country:US
Practice Address - Phone:603-569-2268
Practice Address - Fax:603-569-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30316268Medicaid