Provider Demographics
NPI:1356498778
Name:DR. KATES PREMIER SMILES ORTHODONTICS INC.
Entity Type:Organization
Organization Name:DR. KATES PREMIER SMILES ORTHODONTICS INC.
Other - Org Name:PREMIER SMILES ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-691-9944
Mailing Address - Street 1:13990 CEDAR RD STE A
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3204
Mailing Address - Country:US
Mailing Address - Phone:216-691-9944
Mailing Address - Fax:216-691-9949
Practice Address - Street 1:13990 CEDAR RD STE A
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3204
Practice Address - Country:US
Practice Address - Phone:216-691-9944
Practice Address - Fax:216-691-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH198301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0064406Medicaid