Provider Demographics
NPI:1902782204
Name:GORTON, AUSTIN TYLER (DMD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:TYLER
Last Name:GORTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 S GUM ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5605
Mailing Address - Country:US
Mailing Address - Phone:208-484-5198
Mailing Address - Fax:
Practice Address - Street 1:715 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4153
Practice Address - Country:US
Practice Address - Phone:509-547-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.700225841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice