Mack-Gates, Kenyatta

Mack-Gates, Kenyatta is an individual health care provider with primary practice located at 61 Orange Plaza Ln , Middletown NY 10940-2254. She recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist. Dental Providers / Dentist is her primary health care specialty. Mack-Gates, Kenyatta can be contacted via phone (845) 344-3844.

Contact Information

Primary practice address
61 Orange Plaza Ln Middletown NY 10940-2254
Phone: (845) 344-3844
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 12933 Maryland
Dental Providers / General Practice 1223G0001X 0401411320 Virginia
Dental Providers / Dentist 122300000X 048566 New York

Profile Details

NPI number 1023007374
LBN Legal business name Mack-Gates, Kenyatta
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 19th, 2005
Last updated Jul 31st, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023007374 NPPES
New York MEDICAID 02213830
New York MEDICAID 001746900

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