Healthcare Provider Details

I. General information

NPI: 1619906187
Provider Name (Legal Business Name): KATHLEEN ANN GATES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 17TH ST S STE A
NEWTON IA
50208-4094
US

IV. Provider business mailing address

9340 CANYON DR
WOODLAND PARK CO
80863-7503
US

V. Phone/Fax

Practice location:
  • Phone: 513-808-4984
  • Fax:
Mailing address:
  • Phone: 303-886-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00202725
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-09627
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD3185
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: