Provider Demographics
NPI:1891082616
Name:GATEHOUSE, CHRISTOPHER S (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:GATEHOUSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145R E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2104
Mailing Address - Country:US
Mailing Address - Phone:860-669-2700
Mailing Address - Fax:860-669-7585
Practice Address - Street 1:145R E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2104
Practice Address - Country:US
Practice Address - Phone:860-669-2700
Practice Address - Fax:860-669-7585
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004011136Medicaid