Healthcare Provider Details

I. General information

NPI: 1275681363
Provider Name (Legal Business Name): KATES ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26110 EMERY RD SUITE 100
CLEVELAND OH
44128-5731
US

IV. Provider business mailing address

26110 EMERY RD. SUITE 100
WARRENSVILLE HTS OH
44128-5980
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-7700
  • Fax: 216-464-7950
Mailing address:
  • Phone: 216-464-7700
  • Fax: 216-464-7950

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: DR. DALE A. KATES
Title or Position: ORTHODONTIST
Credential: D.D.S.
Phone: 216-464-7700