Healthcare Provider Details

I. General information

NPI: 1497976070
Provider Name (Legal Business Name): DALE A KATES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SEVERANCE CIR STE 714
CLEVELAND HTS OH
44118-1590
US

IV. Provider business mailing address

5 SEVERANCE CIR STE 714
CLEVELAND HTS OH
44118-1590
US

V. Phone/Fax

Practice location:
  • Phone: 216-691-9944
  • Fax: 216-691-9949
Mailing address:
  • Phone: 216-691-9944
  • Fax: 216-691-9949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number19830
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: