1508762006 NPI number — GATEWAY DENTAL & IMPLANT CENTER

Table of content: (NPI 1508762006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508762006 NPI number — GATEWAY DENTAL & IMPLANT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATEWAY DENTAL & IMPLANT CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508762006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 GATEWAY LANE
Provider Second Line Business Mailing Address:
ST 300
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-524-6600
Provider Business Mailing Address Fax Number:
470-524-6601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 GATEWAY LANE
Provider Second Line Business Practice Location Address:
ST 300
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-524-6600
Provider Business Practice Location Address Fax Number:
470-524-6601
Provider Enumeration Date:
10/20/2026

Additional Information

Authorized Official

Authorized Official Last Name:
TAUFIQ
Authorized Official First Name:
ASIF
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-962-0515

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com