Provider Demographics
NPI:1538165568
Name:GATES, PAUL ALAN (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
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 1:896 SUMMIT STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4370
Mailing Address - Country:US
Mailing Address - Phone:512-244-2644
Mailing Address - Fax:512-218-1788
Practice Address - Street 1:896 SUMMIT ST
Practice Address - Street 2:STE 102
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4370
Practice Address - Country:US
Practice Address - Phone:512-244-2644
Practice Address - Fax:512-218-1788
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
TX185841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics