Basic Information
| Provider Information | |||||||||
| NPI: | 1548541923 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GITTINS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | HOWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7138 S HIGHLAND DR STE 109 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841213776 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 CAISSON HILL RD | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664427037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852387241 | ||||||||
| FaxNumber: | 7852405749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2011 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 6739-15 | WI | N | Dental Providers | Dentist | General Practice | 1223P0700X | 6739-15 | WI | Y | Dental Providers | Dentist | Prosthodontics |
No ID Information.