Healthcare Provider Details

I. General information

NPI: 1225466584
Provider Name (Legal Business Name): BILL GATES DDS MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 SHANNON RD SUITE 101
DURHAM NC
27707-3771
US

IV. Provider business mailing address

3622 SHANNON RD SUITE 101
DURHAM NC
27707-3771
US

V. Phone/Fax

Practice location:
  • Phone: 919-493-1402
  • Fax: 919-403-2392
Mailing address:
  • Phone: 919-493-1402
  • Fax: 919-403-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number6222
License Number StateNC

VIII. Authorized Official

Name: DR. WILLIAM DEE GATES
Title or Position: OWNER
Credential: DDS
Phone: 919-493-1402