Provider Demographics
NPI:1962449850
Name:GATES DENTAL CARE PC
Entity type:Organization
Organization Name:GATES DENTAL CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAMAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAGUIB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-967-1149
Mailing Address - Street 1:8135 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2828
Mailing Address - Country:US
Mailing Address - Phone:847-967-1149
Mailing Address - Fax:847-967-8594
Practice Address - Street 1:302 E SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2420
Practice Address - Country:US
Practice Address - Phone:630-836-4410
Practice Address - Fax:630-563-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019014756204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL33060OtherBLUE SHIELD OF ILLINOIS
IL019014756Medicaid
IL203838Medicare PIN
IL019014756Medicaid