Provider Demographics
NPI:1568220044
Name:GAGLIARDO, VINCENT MICHAEL
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:MICHAEL
Last Name:GAGLIARDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1782 SWEETS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8403
Mailing Address - Country:US
Mailing Address - Phone:585-645-2600
Mailing Address - Fax:
Practice Address - Street 1:1520 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14217-1212
Practice Address - Country:US
Practice Address - Phone:716-768-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist