Provider Demographics
NPI:1871742494
Name:GAUNT FAMILY AND COSMETIC DENTISTRY
Entity type:Organization
Organization Name:GAUNT FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GAUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-753-5403
Mailing Address - Street 1:107 E CENTRAL AVE
Mailing Address - Street 2:PO BOX 710
Mailing Address - City:AVIS
Mailing Address - State:PA
Mailing Address - Zip Code:17721-8904
Mailing Address - Country:US
Mailing Address - Phone:570-753-5403
Mailing Address - Fax:570-753-5485
Practice Address - Street 1:107 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AVIS
Practice Address - State:PA
Practice Address - Zip Code:17721-8904
Practice Address - Country:US
Practice Address - Phone:570-753-5403
Practice Address - Fax:570-753-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022420-L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental