Provider Demographics
NPI:1801093208
Name:INSTITUTE OF ESTHETIC DENTISTRY, INC.
Entity type:Organization
Organization Name:INSTITUTE OF ESTHETIC DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GOWDEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MA
Authorized Official - Phone:916-941-2333
Mailing Address - Street 1:4944 WINDPLAY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9688
Mailing Address - Country:US
Mailing Address - Phone:916-941-2333
Mailing Address - Fax:
Practice Address - Street 1:4944 WINDPLAY DR
Practice Address - Street 2:SUITE 300
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9688
Practice Address - Country:US
Practice Address - Phone:916-941-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38843261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental