Provider Demographics
NPI:1679217517
Name:YVES BETTY GATTEREAU, DDS, PC
Entity Type:Organization
Organization Name:YVES BETTY GATTEREAU, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YVES
Authorized Official - Middle Name:BETTY
Authorized Official - Last Name:GATTEREAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:857-891-7656
Mailing Address - Street 1:46 MEAGHER AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-2754
Mailing Address - Country:US
Mailing Address - Phone:857-891-7656
Mailing Address - Fax:
Practice Address - Street 1:650 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1051
Practice Address - Country:US
Practice Address - Phone:857-891-7656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1124398169Medicaid