Provider Demographics
NPI:1700989282
Name:J GAGLIARDE P PONTE DDS
Entity type:Organization
Organization Name:J GAGLIARDE P PONTE DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-674-8811
Mailing Address - Street 1:1120 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:508-674-8811
Mailing Address - Fax:508-673-6397
Practice Address - Street 1:1120 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-674-8811
Practice Address - Fax:508-673-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA97081223G0001X
MA120711223G0001X
MA116801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9782273Medicaid