Provider Demographics
NPI:1821497132
Name:GATES, DENISE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:C
Last Name:GATES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29990 SW TOWN CENTER LOOP W
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9425
Mailing Address - Country:US
Mailing Address - Phone:503-682-2110
Mailing Address - Fax:503-682-8951
Practice Address - Street 1:29990 SW TOWN CENTER LOOP W
Practice Address - Street 2:SUITE A
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9425
Practice Address - Country:US
Practice Address - Phone:503-682-2110
Practice Address - Fax:503-682-8951
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD101241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice