Provider Demographics
NPI:1447491881
Name:DIMITRI G. GAMIM, DDS
Entity type:Organization
Organization Name:DIMITRI G. GAMIM, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GANIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-725-6140
Mailing Address - Street 1:878 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-2642
Mailing Address - Country:US
Mailing Address - Phone:401-725-6140
Mailing Address - Fax:
Practice Address - Street 1:878 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-2642
Practice Address - Country:US
Practice Address - Phone:401-725-6140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI16611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty