Provider Demographics
NPI:1851565196
Name:JAMES L GATES, DDS, PC
Entity Type:Organization
Organization Name:JAMES L GATES, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-783-6818
Mailing Address - Street 1:318 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-3316
Mailing Address - Country:US
Mailing Address - Phone:276-783-6818
Mailing Address - Fax:276-783-2263
Practice Address - Street 1:318 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-3316
Practice Address - Country:US
Practice Address - Phone:276-783-6818
Practice Address - Fax:276-783-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA141620OtherANTHEM