Provider Demographics
NPI:1619602273
Name:GAUTHIER, ALAINA RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAINA
Middle Name:RAE
Last Name:GAUTHIER
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 1:1909 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4707
Mailing Address - Country:US
Mailing Address - Phone:337-254-9008
Mailing Address - Fax:
Practice Address - Street 1:3001 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3603
Practice Address - Country:US
Practice Address - Phone:405-840-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice