Provider Demographics
NPI:1093849788
Name:GEGAUFF, ANTHONY GUSTAV (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GUSTAV
Last Name:GEGAUFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-9203
Mailing Address - Country:US
Mailing Address - Phone:970-626-9742
Mailing Address - Fax:
Practice Address - Street 1:156 LIDDELL DR
Practice Address - Street 2:
Practice Address - City:RIDGWAY, CO
Practice Address - State:CO
Practice Address - Zip Code:81432
Practice Address - Country:US
Practice Address - Phone:970-626-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86951223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics