Provider Demographics
NPI:1144113630
Name:GAYTAN, ABEL ALFONSO (DDS)
Entity type:Individual
Prefix:DR
First Name:ABEL
Middle Name:ALFONSO
Last Name:GAYTAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 HOLLY AVE NE APT 1208
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3078
Mailing Address - Country:US
Mailing Address - Phone:575-910-2636
Mailing Address - Fax:
Practice Address - Street 1:2424 LOUISIANA BLVD NE STE 501
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4361
Practice Address - Country:US
Practice Address - Phone:505-348-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDB-2025-00951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice