Provider Demographics
NPI:1194735464
Name:GATES, JOHN K (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:GATES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MILL ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-1948
Mailing Address - Country:US
Mailing Address - Phone:570-275-7730
Mailing Address - Fax:570-275-6099
Practice Address - Street 1:104 MILL ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-1948
Practice Address - Country:US
Practice Address - Phone:570-275-7730
Practice Address - Fax:570-275-6099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02366OL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice