Provider Demographics
NPI:1871096172
Name:DAVID GAMACHE
Entity type:Organization
Organization Name:DAVID GAMACHE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMACHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-597-1123
Mailing Address - Street 1:602 ROUTE 72 E
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3504
Mailing Address - Country:US
Mailing Address - Phone:609-978-1111
Mailing Address - Fax:609-597-1111
Practice Address - Street 1:602 ROUTE 72 E
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3504
Practice Address - Country:US
Practice Address - Phone:609-978-1111
Practice Address - Fax:609-597-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15711261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherALL