Provider Demographics
NPI:1568694305
Name:GORDON N GATES DDS, MSD, PC
Entity Type:Organization
Organization Name:GORDON N GATES DDS, MSD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:303-530-9694
Mailing Address - Street 1:350 BROADWAY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-3338
Mailing Address - Country:US
Mailing Address - Phone:303-494-7110
Mailing Address - Fax:303-554-1168
Practice Address - Street 1:350 BROADWAY ST STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3338
Practice Address - Country:US
Practice Address - Phone:303-494-7110
Practice Address - Fax:303-554-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1009451223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty