Provider Demographics
NPI:1003912841
Name:GATES, PAM R
Entity Type:Individual
Prefix:MRS
First Name:PAM
Middle Name:R
Last Name:GATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 EUDORA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-5719
Mailing Address - Country:US
Mailing Address - Phone:303-399-4625
Mailing Address - Fax:303-781-6911
Practice Address - Street 1:3501 S CORONA ST STE 5
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3907
Practice Address - Country:US
Practice Address - Phone:303-781-6911
Practice Address - Fax:303-781-0746
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist