Provider Demographics
NPI:1891722252
Name:GOTTMAN, ERIC EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:EUGENE
Last Name:GOTTMAN
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 1:650 E 25T STREET
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2784
Mailing Address - Country:US
Mailing Address - Phone:816-235-2100
Mailing Address - Fax:816-235-5472
Practice Address - Street 1:650 E 25T STREET
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2784
Practice Address - Country:US
Practice Address - Phone:816-235-2100
Practice Address - Fax:816-235-5472
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010135311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO404810509Medicaid
MO430926003OtherTIN