Provider Demographics
NPI:1700698875
Name:AQUARIAN DENTAL LLC
Entity type:Organization
Organization Name:AQUARIAN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGLIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-251-4112
Mailing Address - Street 1:2788 STELZER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3131
Mailing Address - Country:US
Mailing Address - Phone:614-476-3368
Mailing Address - Fax:
Practice Address - Street 1:2788 STELZER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3131
Practice Address - Country:US
Practice Address - Phone:614-476-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice