Healthcare Provider Details

I. General information

NPI: 1669693347
Provider Name (Legal Business Name): DANIEL EDWARD BATES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 HAMILTON RD. USA DENTAL ACTIVITY
FORT SILL OK
73503
US

IV. Provider business mailing address

652 HAMILTON RD. USA DENTAL ACTIVITY
FORT SILL OK
73503
US

V. Phone/Fax

Practice location:
  • Phone: 580-442-5518
  • Fax:
Mailing address:
  • Phone: 580-442-5518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberMT 2046
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: