Provider Demographics
NPI:1134630163
Name:DR. KATES PREMIER SMILES ORTHODONTICS INC
Entity type:Organization
Organization Name:DR. KATES PREMIER SMILES ORTHODONTICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-395-7336
Mailing Address - Street 1:9179 MENTOR AVE STE K
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6398
Mailing Address - Country:US
Mailing Address - Phone:440-205-1222
Mailing Address - Fax:440-974-5474
Practice Address - Street 1:9179 MENTOR AVE STE K
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6398
Practice Address - Country:US
Practice Address - Phone:440-205-1222
Practice Address - Fax:440-974-5474
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. KATES PREMIER SMILES ORTHODONTICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0198301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty