Provider Demographics
NPI:1104852110
Name:GATES, GUSTAV E (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUSTAV
Middle Name:E
Last Name:GATES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 SCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6815
Mailing Address - Country:US
Mailing Address - Phone:254-778-3587
Mailing Address - Fax:254-778-6484
Practice Address - Street 1:3013 SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6815
Practice Address - Country:US
Practice Address - Phone:254-778-3587
Practice Address - Fax:254-778-6484
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice