Provider Demographics
NPI:1538567896
Name:GILLETTE, DANA MARIE
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:MARIE
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 CENTENNIAL BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4405
Mailing Address - Country:US
Mailing Address - Phone:719-402-3232
Mailing Address - Fax:719-402-3232
Practice Address - Street 1:5245 CENTENNIAL BLVD STE 207
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-4405
Practice Address - Country:US
Practice Address - Phone:719-402-3232
Practice Address - Fax:719-402-3232
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH070090124Q00000X
NY024528124Q00000X
CODH.002023537124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist