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General NPI Number Information
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NPI Number | 1801911870
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Entity Type | Individual
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Provider Name | MICHELLE LYNN GAETH D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 11536 S. 31ST ST.
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City | BELLEVUE
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State | NE
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Zip | 68123
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Country | US
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Telephone | 402-291-4468
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Fax | 402-933-2014
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Provider Business Mailing Address
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Address Line | 3414 N. 161ST. AVE
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City | OMAHA
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State | NE
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Zip | 68116
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Country | US
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Telephone | 402-291-4468
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Fax | 402-933-2014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6129
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6129
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License Number State | NE
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