Provider Demographics
NPI:1801911870
Name:GAETH, MICHELLE LYNN (DDS)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:GAETH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:HATCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3414 N. 161ST. AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116
Mailing Address - Country:US
Mailing Address - Phone:402-291-4468
Mailing Address - Fax:402-933-2014
Practice Address - Street 1:11536 S. 31ST ST.
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123
Practice Address - Country:US
Practice Address - Phone:402-291-4468
Practice Address - Fax:402-933-2014
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6129122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice