1992768857 NPI number — GATEWAY FAMILY DENTISTRY, INC.

Table of content: LORRE ROYANNE ANDERSON MS, LPC (NPI 1003074394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992768857 NPI number — GATEWAY FAMILY DENTISTRY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATEWAY FAMILY DENTISTRY, INC.
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:
1992768857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 E WARNER RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85225-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-857-0745
Provider Business Mailing Address Fax Number:
480-917-8955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 E WARNER RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85225-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-857-0745
Provider Business Practice Location Address Fax Number:
480-917-8955
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAILEY
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-857-0745

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5922 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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