MEDICARE: DR. KATES PREMIER SMILES ORTHODONTICS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	19830	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356498778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. KATES PREMIER SMILES ORTHODONTICS INC.

Provider Business Mailing Address
First Line	:	13990 CEDAR RD STE A
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3204
Country	:	US
Telephone Number	:	216-691-9944
Fax Number	:	216-691-9949

Provider Business Practice Location Address
First Line	:	13990 CEDAR RD STE A
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3204
Country	:	US
Telephone Number	:	216-691-9944
Fax Number	:	216-691-9949

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DALE A. KATES
Credential	:	DDS
Telephone Number	:	216-691-9944

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	12/05/2019

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