Provider Demographics
NPI:1356447338
Name:GATEWAY DENTAL, P.C.
Entity Type:Organization
Organization Name:GATEWAY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUY
Authorized Official - Middle Name:TAM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-369-5517
Mailing Address - Street 1:1076 S SABLE BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3796
Mailing Address - Country:US
Mailing Address - Phone:303-369-5517
Mailing Address - Fax:303-369-5517
Practice Address - Street 1:1076 S SABLE BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3796
Practice Address - Country:US
Practice Address - Phone:303-369-5517
Practice Address - Fax:303-369-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02069912Medicaid
CO84056OtherDELTA DENTAL
CO812293OtherUNITED CONCORDIA ID
CO60054OtherAETNA PAYOR ID
CO65978OtherMETLIFE