Individual
DR. GARY FRANK CIRCOSTA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
93 VAN DEENE AVE, WEST SPRINGFIELD, MA 01089-3236
(413) 734-9400
(413) 734-9408
Mailing address
5 BEECHWOOD DR, RUTLAND, MA 01543-1751
(508) 886-6451
(508) 886-0167
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11938
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0209821
—
MA
Enumeration date
10/12/2005
Last updated
07/08/2007
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