Organization
GINO A GISMONDI DDS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOCELYN NICOLE VILAIN (OFFICE MANAGER)
(304) 622-4828
Entity
Organization
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
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3781
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001750853
UNITED CONCORDIA
WV
01
—
3073126
UNITED CONCORDIA
WV
05
—
3810000420
—
WV
05
—
3810026369
—
WV
01
—
3910006064
MEDICAID GROUP
WV
Enumeration date
06/23/2014
Last updated
02/03/2016
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