1275681363 NPI number — KATES ORTHODONTICS

Table of content: (NPI 1275681363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275681363 NPI number — KATES ORTHODONTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATES ORTHODONTICS
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:
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:
1275681363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26110 EMERY RD.
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WARRENSVILLE HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44128-5980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-464-7700
Provider Business Mailing Address Fax Number:
216-464-7950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26110 EMERY RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44128-5731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-464-7700
Provider Business Practice Location Address Fax Number:
216-464-7950
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KATES
Authorized Official First Name:
DALE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
216-464-7700

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)





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