Gregory M Gazzola, DMD
Individual provider Active NPI General Practice Dentistry · Grosvenordale, CT
NPI 1124185038 · NPPES record last updated Sep 25, 2015
Key facts
- NPI
- 1124185038
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 7071 (CT)
- Practice address
- 520 Riverside Drive
Grosvenordale, CT 06246 - Phone
- (860) 923-2202
- Fax
- (860) 923-9956
- NPI assigned
- Jan 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7071 | CT | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thompson Smiles PLLC | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7071 | CT | Yes |
Addresses
Primary practice location
520 Riverside Drive
Grosvenordale, CT 06246
Mailing address
PO Box 8
Grosvenor Dale, CT 06246-0008
Phone (860) 923-2202
Other providers in Grosvenordale, CT
All providers in Grosvenordale, CT · General Practice Dentistry in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.