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General NPI Number Information
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NPI Number | 1821675372
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Entity Type | Individual
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Provider Name | MATTHEW IAN GAMACHE DDS
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Gender | Male
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 15022 E MISSISSIPPI AVE
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City | AURORA
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State | CO
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Zip | 80012-3728
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Country | US
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Telephone | 720-826-0115
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Fax |
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Provider Business Mailing Address
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Address Line | 1907 NORTHMOOR TER
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City | PUEBLO
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State | CO
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Zip | 81008-1503
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Country | US
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Telephone | 719-557-1529
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Fax |
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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 | DEN.00204810
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License Number State | CO
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