Healthcare Provider Details

I. General information

NPI: 1023040193
Provider Name (Legal Business Name): GEORGE ADDISON KATES D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLD BEACH RD
NEWPORT RI
02840-3285
US

IV. Provider business mailing address

15 OLD BEACH RD
NEWPORT RI
02840-3285
US

V. Phone/Fax

Practice location:
  • Phone: 401-849-4790
  • Fax: 401-847-3020
Mailing address:
  • Phone: 401-849-4790
  • Fax: 401-847-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN01670
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: