Provider Demographics
NPI:1255740734
Name:GATEWAY DENTISTRY P.C.
Entity type:Organization
Organization Name:GATEWAY DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMMON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-783-2273
Mailing Address - Street 1:228 W 200 S SUITE 1A
Mailing Address - Street 2:
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036
Mailing Address - Country:US
Mailing Address - Phone:435-783-2273
Mailing Address - Fax:435-783-4357
Practice Address - Street 1:228 W 200 S SUITE 1A
Practice Address - Street 2:
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036
Practice Address - Country:US
Practice Address - Phone:435-783-2273
Practice Address - Fax:435-783-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6508336-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental