Provider Demographics
NPI:1285623231
Name:GATES, GREGORY P (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:GATES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 DAKOTA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COALPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16627-8975
Mailing Address - Country:US
Mailing Address - Phone:814-687-3891
Mailing Address - Fax:
Practice Address - Street 1:1800 DAKOTA RIDGE RD
Practice Address - Street 2:
Practice Address - City:COALPORT
Practice Address - State:PA
Practice Address - Zip Code:16627-8975
Practice Address - Country:US
Practice Address - Phone:814-687-3891
Practice Address - Fax:814-687-3891
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026403L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01138545Medicaid
PA01138545OtherMEDPLUS