MEDICARE: BILL GATES DDS MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	6222	NC

General Provider Information

NPI Number	:	1225466584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BILL GATES DDS MS

Provider Business Mailing Address
First Line	:	3622 SHANNON RD
Second Line	:	SUITE 101
City	:	DURHAM
State	:	NC
Zip	:	27707-3771
Country	:	US
Telephone Number	:	919-493-1402
Fax Number	:	919-403-2392

Provider Business Practice Location Address
First Line	:	3622 SHANNON RD
Second Line	:	SUITE 101
City	:	DURHAM
State	:	NC
Zip	:	27707-3771
Country	:	US
Telephone Number	:	919-493-1402
Fax Number	:	919-403-2392

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM DEE GATES
Credential	:	DDS
Telephone Number	:	919-493-1402

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	10/24/2013

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