Provider Demographics
NPI:1619170578
Name:GORRITY, ALTINAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALTINAI
Middle Name:
Last Name:GORRITY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19125 N US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4258
Mailing Address - Country:US
Mailing Address - Phone:813-949-4568
Mailing Address - Fax:813-949-5012
Practice Address - Street 1:19125 N US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4258
Practice Address - Country:US
Practice Address - Phone:813-949-4568
Practice Address - Fax:813-949-5012
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist