Healthcare Provider Details

I. General information

NPI: 1952366155
Provider Name (Legal Business Name): CAROL STEWART BATES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: CAROL MARIE STEWART DDS

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100425 1600 SW ARCHER ROAD, D4-4
GAINESVILLE FL
32610-0425
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5380
  • Fax: 352-392-3070
Mailing address:
  • Phone: 352-273-5380
  • Fax: 352-392-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberTP097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: