1356435077 NPI number — DR. B GAIL DEMKO DMD,

Table of content: DR. B GAIL DEMKO DMD, (NPI 1356435077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356435077 NPI number — DR. B GAIL DEMKO DMD,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMKO
Provider First Name:
B
Provider Middle Name:
GAIL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356435077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02493-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-964-4028
Provider Business Mailing Address Fax Number:
617-595-4591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 MERRIAM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02493-1319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-964-4028
Provider Business Practice Location Address Fax Number:
617-595-4591
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  14113 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223D0001X , with the licence number: 12010332A , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6491640001 . This is a "PTAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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