Healthcare Provider Details

I. General information

NPI: 1407854888
Provider Name (Legal Business Name): DURWIN LEE GATES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 ROSTRAVER RD
BELLE VERNON PA
15012-1947
US

IV. Provider business mailing address

956 ROSTRAVER RD
BELLE VERNON PA
15012-1947
US

V. Phone/Fax

Practice location:
  • Phone: 724-929-2254
  • Fax: 724-929-2255
Mailing address:
  • Phone: 724-929-2254
  • Fax: 724-929-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS022354-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: