Provider Demographics
NPI:1942424767
Name:GAGNON, WILLIAM L (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:GAGNON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051
Mailing Address - Country:US
Mailing Address - Phone:603-889-8499
Mailing Address - Fax:603-889-2199
Practice Address - Street 1:5 GEORGE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051
Practice Address - Country:US
Practice Address - Phone:603-889-8499
Practice Address - Fax:603-889-2199
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH2001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist