Provider Demographics
NPI:1962675793
Name:GATE, JAMISON MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMISON
Middle Name:MARK
Last Name:GATE
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 1:10 LIBERTY SHIP WAY
Mailing Address - Street 2:108
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-3312
Mailing Address - Country:US
Mailing Address - Phone:415-332-1411
Mailing Address - Fax:
Practice Address - Street 1:425 E REMINGTON DR
Practice Address - Street 2:SUITE 4
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1980
Practice Address - Country:US
Practice Address - Phone:408-733-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice