1134630163 NPI number — DR. KATES PREMIER SMILES ORTHODONTICS INC

Table of content: (NPI 1134630163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134630163 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:
Provider Other Organization Name Type Code:
6
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:
1134630163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9179 MENTOR AVE STE K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENTOR
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44060-6398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-205-1222
Provider Business Mailing Address Fax Number:
440-974-5474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9179 MENTOR AVE STE K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENTOR
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44060-6398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-205-1222
Provider Business Practice Location Address Fax Number:
440-974-5474
Provider Enumeration Date:
10/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
NAKIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
216-395-7336

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  30.019830 , 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)





Copyright © 2007-2025 www.npivalidator.com