Provider Demographics
NPI:1235214685
Name:GAMMAGE, DANIEL SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SCOTT
Last Name:GAMMAGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SAINT ANN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3394
Mailing Address - Country:US
Mailing Address - Phone:985-727-1830
Mailing Address - Fax:985-727-1838
Practice Address - Street 1:215 SAINT ANN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3394
Practice Address - Country:US
Practice Address - Phone:985-727-1830
Practice Address - Fax:985-727-1838
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice