Individual
DENTRAVIOUS GATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 HILL TOP HTS, BALDWYN, MS 38824-9783
(662) 216-6672
Mailing address
220 HILL TOP HTS, BALDWYN, MS 38824-9783
(662) 216-6672
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
6841
MS
Other
Enumeration date
07/29/2024
Last updated
07/29/2024
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