Healthcare Provider Details

I. General information

NPI: 1548541923
Provider Name (Legal Business Name): JOHN HOWARD GITTINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CAISSON HILL RD USA DENTAC
FT RILEY KS
66442-7037
US

IV. Provider business mailing address

7138 S HIGHLAND DR STE 109
SALT LAKE CITY UT
84121-3776
US

V. Phone/Fax

Practice location:
  • Phone: 785-238-7241
  • Fax: 785-240-5749
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6739-15
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number6739-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: