Provider Demographics
NPI:1689868762
Name:GATAN, SIRINTRA (DMD)
Entity Type:Individual
Prefix:
First Name:SIRINTRA
Middle Name:
Last Name:GATAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7175 W LAKE MEAD BLVD
Mailing Address - Street 2:#110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1302
Mailing Address - Country:US
Mailing Address - Phone:702-228-9911
Mailing Address - Fax:702-228-9344
Practice Address - Street 1:7175 W LAKE MEAD BLVD
Practice Address - Street 2:#110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1302
Practice Address - Country:US
Practice Address - Phone:702-228-9911
Practice Address - Fax:702-228-9344
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA037290122300000X
NV5598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist