Provider Demographics
NPI:1619906187
Name:GATES, KATHLEEN ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:GATES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-7503
Mailing Address - Country:US
Mailing Address - Phone:303-886-4155
Mailing Address - Fax:
Practice Address - Street 1:56720 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:CALUMET
Practice Address - State:MI
Practice Address - Zip Code:49913-1967
Practice Address - Country:US
Practice Address - Phone:906-483-1177
Practice Address - Fax:906-483-1394
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD31851223G0001X
CODEN.002027251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice