Provider Demographics
NPI:1548693476
Name:GASANOVA, EMMA (DMD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:GASANOVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20455 ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-7516
Mailing Address - Country:US
Mailing Address - Phone:724-776-4105
Mailing Address - Fax:724-776-4106
Practice Address - Street 1:20455 ROUTE 19
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-7516
Practice Address - Country:US
Practice Address - Phone:724-776-4105
Practice Address - Fax:724-776-4106
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0396601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice