Provider Demographics
NPI:1558423475
Name:GAUTHIER, GREGORY JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:GAUTHIER
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 1:16638 BRIGADOON DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1039
Mailing Address - Country:US
Mailing Address - Phone:813-494-4050
Mailing Address - Fax:813-972-0765
Practice Address - Street 1:16638 BRIGADOON DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1039
Practice Address - Country:US
Practice Address - Phone:813-494-4050
Practice Address - Fax:813-972-0765
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist