Healthcare Provider Details

I. General information

NPI: 1740536663
Provider Name (Legal Business Name): SHELDON ANTHONY BATES D.M.D., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2012
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 STILLMAN PKWY SUITE 101
HENRICO VA
23233-1455
US

IV. Provider business mailing address

3800 STILLMAN PKWY SUITE 101
HENRICO VA
23233-1455
US

V. Phone/Fax

Practice location:
  • Phone: 804-934-9292
  • Fax: 804-934-9290
Mailing address:
  • Phone: 804-934-9292
  • Fax: 804-934-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401413495
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: