# GAUNT FAMILY AND COSMETIC DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871742494
- **Authorized official:** DR. JAY ROBERT GAUNT DDS (OWNER)
- **Authorized official phone:** (570) 753-5403

## Contact information

- **Practice address:** 107 E CENTRAL AVE, AVIS, PA 17721-8904
- **Practice address phone:** (570) 753-5403
- **Practice address fax:** (570) 753-5485
- **Mailing address:** 107 E CENTRAL AVE, PO BOX 710, AVIS, PA 17721-8904
- **Mailing address phone:** (570) 753-5403
- **Mailing address fax:** (570) 753-5485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DS-022420-L | PA | Yes |

## Other

- **Enumeration date:** 09/18/2008
- **Last updated:** 09/18/2008