Provider Demographics
NPI:1336718170
Name:BILL GATES DDS MS
Entity Type:Organization
Organization Name:BILL GATES DDS MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-307-1919
Mailing Address - Street 1:104 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8096
Mailing Address - Country:US
Mailing Address - Phone:201-307-1919
Mailing Address - Fax:
Practice Address - Street 1:104 BROADWAY
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8096
Practice Address - Country:US
Practice Address - Phone:201-307-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty