Provider Demographics
NPI:1710373998
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:216-916-7772
Mailing Address - Street 1:29100 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-4659
Mailing Address - Country:US
Mailing Address - Phone:216-916-7772
Mailing Address - Fax:216-691-9949
Practice Address - Street 1:26300 EUCLID AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3708
Practice Address - Country:US
Practice Address - Phone:216-916-7772
Practice Address - Fax:216-691-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty