Provider Demographics
NPI:1912216128
Name:GATEWOOD, ROBERT ROY (DDS, MS, PERIOD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ROY
Last Name:GATEWOOD
Suffix:
Gender:M
Credentials:DDS, MS, PERIOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 EAST CHALAN SANTO PAPA
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910
Mailing Address - Country:US
Mailing Address - Phone:671-477-2379
Mailing Address - Fax:671-477-2387
Practice Address - Street 1:222 EAST CHALAN SANTO PAPA
Practice Address - Street 2:SUITE 303
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-477-2379
Practice Address - Fax:671-477-2387
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD-8151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics