Provider Demographics
NPI:1821675372
Name:GAMACHE, MATTHEW IAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:IAN
Last Name:GAMACHE
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 1:1907 NORTHMOOR TER
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1503
Mailing Address - Country:US
Mailing Address - Phone:719-557-1529
Mailing Address - Fax:
Practice Address - Street 1:15022 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3728
Practice Address - Country:US
Practice Address - Phone:720-826-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist