MEDICARE: MS. DANA MARIE GILLETTE

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	124Q00000X	Dental Hygienist	DH070090	PA
2	124Q00000X	Dental Hygienist	024528	NY
3	124Q00000X	Dental Hygienist	DH.002023537	CO

General Provider Information

NPI Number	:	1538567896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA MARIE GILLETTE

Provider Business Mailing Address
First Line	:	5245 CENTENNIAL BLVD STE 207
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4405
Country	:	US
Telephone Number	:	719-402-3232
Fax Number	:	719-402-3232

Provider Business Practice Location Address
First Line	:	5245 CENTENNIAL BLVD STE 207
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4405
Country	:	US
Telephone Number	:	719-402-3232
Fax Number	:	719-402-3232

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

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	03/07/2025

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