MEDICARE: DR. DEREK BRADFORD GATTA D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN 18725	FL

General Provider Information

NPI Number	:	1477880797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK BRADFORD GATTA D.M.D

Provider Business Mailing Address
First Line	:	8 LUCAS AVE
Second Line	:
City	:	NEWPORT
State	:	RI
Zip	:	02840-3918
Country	:	US
Telephone Number	:	646-415-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 US HIGHWAY 441 STE 301
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4380
Country	:	US
Telephone Number	:	561-285-7902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	07/21/2022

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