Provider Demographics
NPI:1659340362
Name:GATES, GREGORY RAY (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:RAY
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 1:4102 PINION DR STE 100
Mailing Address - Street 2:10TH MEDICAL GROUP
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-5190
Mailing Address - Fax:719-333-5268
Practice Address - Street 1:4102 PINION DR STE 100
Practice Address - Street 2:10TH MEDICAL GROUP
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5190
Practice Address - Fax:719-333-5268
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice