Individual
JAIME GATENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
6560 FANNIN ST STE 1280, HOUSTON, TX 77030
(713) 441-5577
Mailing address
6560 FANNIN ST STE 1280, HOUSTON, TX 77030-2753
(713) 441-5577
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
J5328
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126772607
—
TX
05
—
126772608
—
TX
01
—
8S5700
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/12/2006
Last updated
03/04/2019
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