Organization
LEGACY DENTAL PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY LOUIS GUSMEROTTI DDS (PRESIDENT)
(585) 720-1370
Entity
Organization
Contact information
Practice address
190 FERGUSON DR, HILTON, NY 14468-9504
(585) 720-1370
Mailing address
31 ERIE CANAL DR, SUITE H, ROCHESTER, NY 14626-4602
(585) 720-1370
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
053408
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477611432
NPPES
NY
Enumeration date
08/04/2008
Last updated
08/04/2008
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