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General NPI Number Information
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NPI Number | 1114538253
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Entity Type | Organization
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Legal Business Name | MARK K BATESOLE, DDS, MS, INC
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 178 S VICTORIA AVE STE C
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City | VENTURA
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State | CA
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Zip | 93003-4369
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Country | US
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Telephone | 805-628-2425
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Fax |
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Provider Business Mailing Address
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Address Line | 1055 BANGOR LN
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City | VENTURA
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State | CA
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Zip | 93001-3820
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Country | US
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Telephone | 949-374-6458
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK KENNETH BATESOLE
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Credential | DDS, MS
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Telephone | 805-628-2425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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