Provider Demographics
NPI:1447260310
Name:GATES, BENJAMIN L (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:L
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 1:2165 N MERRITT CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:COEURD'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815
Mailing Address - Country:US
Mailing Address - Phone:208-667-8282
Mailing Address - Fax:208-667-9557
Practice Address - Street 1:2165 N MERRITT CREEK LOOP
Practice Address - Street 2:
Practice Address - City:COEURD'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815
Practice Address - Country:US
Practice Address - Phone:208-667-8282
Practice Address - Fax:208-667-9557
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID33551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice