Organization
GATEWAY DENTAL PROVIDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW HOGAN (COO)
(717) 636-1907
Entity
Organization
Contact information
Practice address
5901 MARKET ST STE A, PHILADELPHIA, PA 19139-3117
(717) 608-3140
Mailing address
5901 MARKET ST STE A, PHILADELPHIA, PA 19139-3117
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/27/2023
Last updated
12/22/2023
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