MEDICARE: DR. DEBORAH BATES LIVEOAK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3865	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51090171	OTHER	AL	BLUE CROSS PROVIDER NUMBE
2	872873	OTHER	AL	UNITED CONCORDIA PROVIDER

General Provider Information

NPI Number	:	1912058710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH BATES LIVEOAK DMD

Provider Business Mailing Address
First Line	:	2227 DRAKE AVE SW
Second Line	:	BRAHAN SPRINGS PROFESSIONAL VILLAGE SUITE 10A
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805
Country	:	US
Telephone Number	:	256-882-2227
Fax Number	:	256-882-2252

Provider Business Practice Location Address
First Line	:	2227 DRAKE AVE SW
Second Line	:	BRAHAN SPRINGS PROFESSIONAL VILLAGE SUITE 10A
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805
Country	:	US
Telephone Number	:	256-882-2227
Fax Number	:	256-882-2252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. DEBORAH BATES LIVEOAK DMD” Practice Location

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