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General NPI Number Information
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NPI Number | 1215500301
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Entity Type | Individual
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Provider Name | CARMEN MARIE BATES RDH
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Gender | Female
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 116 SEYMOUR ST
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City | BLOSSBURG
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State | PA
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Zip | 16912-1418
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Country | US
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Telephone | 570-638-3468
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Fax |
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Provider Business Mailing Address
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Address Line | 470 WHEELER RD
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City | GILLETT
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State | PA
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Zip | 16925-9306
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Country | US
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Telephone | 570-463-3998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH074676
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License Number State | PA
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