Provider Demographics
NPI:1881631760
Name:KATES, CHARLES H (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:KATES
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 1:1 NE 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3409
Mailing Address - Country:US
Mailing Address - Phone:305-651-6442
Mailing Address - Fax:305-651-5722
Practice Address - Street 1:1 NE 168TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3409
Practice Address - Country:US
Practice Address - Phone:305-651-6442
Practice Address - Fax:305-651-5722
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN46161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT88101Medicare UPIN