Individual
MR. GINO ANTHONY GISMONDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
700 W PIKE ST, SUITE 100, CLARKSBURG, WV 26301-2696
(304) 622-4828
(304) 624-0977
Mailing address
700 W PIKE ST, SUITE 100, CLARKSBURG, WV 26301-2696
(304) 622-4828
(304) 624-0977
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
WV3781
WV
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3781
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002997279
UNITED CONCORIDA
WV
05
—
3810026369
—
WV
Enumeration date
07/19/2007
Last updated
02/03/2016
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