Provider Demographics
NPI:1104430289
Name:BATES ORTHODONTICS, PLC
Entity type:Organization
Organization Name:BATES ORTHODONTICS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:651-343-9182
Mailing Address - Street 1:14755 VICTOR HUGO BLVD N
Mailing Address - Street 2:STE 103
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038
Mailing Address - Country:US
Mailing Address - Phone:651-429-0094
Mailing Address - Fax:
Practice Address - Street 1:14755 VICTOR HUGO BLVD N
Practice Address - Street 2:STE 103
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038
Practice Address - Country:US
Practice Address - Phone:651-429-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty