Provider Demographics
NPI:1295035020
Name:GATTEN, DUSTIN LEE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:LEE
Last Name:GATTEN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N CALGARY CT STE 301
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4000
Mailing Address - Country:US
Mailing Address - Phone:208-262-2620
Mailing Address - Fax:
Practice Address - Street 1:602 N CALGARY CT STE 301
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4000
Practice Address - Country:US
Practice Address - Phone:208-262-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4318-EN1223E0200X
WADE 601713381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics