Healthcare Provider Details

I. General information

NPI: 1750310413
Provider Name (Legal Business Name): BENJAMIN LEE GATES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MAIN AVE S
BROOKINGS SD
57006-3118
US

IV. Provider business mailing address

305 MAIN AVE S
BROOKINGS SD
57006-3118
US

V. Phone/Fax

Practice location:
  • Phone: 605-692-2820
  • Fax: 605-692-9116
Mailing address:
  • Phone: 605-692-2820
  • Fax: 605-692-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: