Provider Demographics
NPI:1689600066
Name:GATLIN, LONNY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:LONNY
Middle Name:JAMES
Last Name:GATLIN
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 1:1202 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1914
Mailing Address - Country:US
Mailing Address - Phone:814-454-4530
Mailing Address - Fax:814-456-2375
Practice Address - Street 1:1720 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16503-1808
Practice Address - Country:US
Practice Address - Phone:814-454-4530
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0355721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice