Provider Demographics
NPI:1629311626
Name:JEFFREY J. KATES, PA
Entity Type:Organization
Organization Name:JEFFREY J. KATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-433-4999
Mailing Address - Street 1:2136 W FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-5132
Mailing Address - Country:US
Mailing Address - Phone:850-529-3907
Mailing Address - Fax:
Practice Address - Street 1:2136 W FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-5132
Practice Address - Country:US
Practice Address - Phone:850-529-3907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-10082122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty