Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 105812 | CO |
NPI | 1003912841 |
---|---|
Provider Name | Mrs. Pam R Gates |
First Address | Denver, CO 80220-5719 |
Second Address | Englewood, CO 80113-3907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 30/05/2008 |