Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DEN01670 | RI |
NPI | 1023040193 |
---|---|
Provider Name | Dr. George Addison Kates |
First Address | Newport, RI 02840-3285 |
Second Address | Newport, RI 02840-3285 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |