Provider Demographics
NPI:1265984041
Name:GATEWAY DENTAL CARE, PLC
Entity type:Organization
Organization Name:GATEWAY DENTAL CARE, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONFORTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-446-2700
Mailing Address - Street 1:25660 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8046
Mailing Address - Country:US
Mailing Address - Phone:248-446-2700
Mailing Address - Fax:
Practice Address - Street 1:51611 TEN MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9720
Practice Address - Country:US
Practice Address - Phone:248-278-0031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY DENTAL CARE I, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty