Provider Demographics
NPI:1235115379
Name:FRANCO, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:FRANCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3129
Mailing Address - Country:US
Mailing Address - Phone:718-444-8484
Mailing Address - Fax:718-444-8484
Practice Address - Street 1:1610 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3129
Practice Address - Country:US
Practice Address - Phone:718-444-8484
Practice Address - Fax:718-444-8484
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist