Provider Demographics
NPI:1821582842
Name:GAMMENTHALER, DOUGLAS J (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:GAMMENTHALER
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 1:2886 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-0335
Mailing Address - Country:US
Mailing Address - Phone:479-899-6444
Mailing Address - Fax:479-899-6605
Practice Address - Street 1:2886 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-0335
Practice Address - Country:US
Practice Address - Phone:479-899-6444
Practice Address - Fax:479-899-6605
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist