Provider Demographics
NPI:1093258105
Name:DR. KATES GROWING SMILES CHILDRENS DENTISTRY LLC
Entity type:Organization
Organization Name:DR. KATES GROWING SMILES CHILDRENS DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-691-9944
Mailing Address - Street 1:13990 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3204
Mailing Address - Country:US
Mailing Address - Phone:216-691-9944
Mailing Address - Fax:216-691-9949
Practice Address - Street 1:13990 CEDAR RD STE B
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3200
Practice Address - Country:US
Practice Address - Phone:216-395-7336
Practice Address - Fax:216-417-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty