Provider Demographics
NPI:1730396060
Name:MANNARINO, GABRIEL (DDS)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:MANNARINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 WESTVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7352
Mailing Address - Country:US
Mailing Address - Phone:313-300-8995
Mailing Address - Fax:
Practice Address - Street 1:27 N WILLARD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3312
Practice Address - Country:US
Practice Address - Phone:802-862-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0186561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice