1356498778 NPI number — DR. KATES PREMIER SMILES ORTHODONTICS INC.

Table of content: (NPI 1356498778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356498778 NPI number — DR. KATES PREMIER SMILES ORTHODONTICS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. KATES PREMIER SMILES ORTHODONTICS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PREMIER SMILES ORTHODONTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356498778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13990 CEDAR RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIVERSITY HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44118-3204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-691-9944
Provider Business Mailing Address Fax Number:
216-691-9949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13990 CEDAR RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44118-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-691-9944
Provider Business Practice Location Address Fax Number:
216-691-9949
Provider Enumeration Date:
01/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KATES
Authorized Official First Name:
DALE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
216-691-9944

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  19830 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0064406 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".