Provider Demographics
NPI:1215500301
Name:BATES, CARMEN MARIE (RDH)
Entity type:Individual
Prefix:MISS
First Name:CARMEN
Middle Name:MARIE
Last Name:BATES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:GILLETT
Mailing Address - State:PA
Mailing Address - Zip Code:16925-9306
Mailing Address - Country:US
Mailing Address - Phone:570-463-3998
Mailing Address - Fax:
Practice Address - Street 1:116 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:BLOSSBURG
Practice Address - State:PA
Practice Address - Zip Code:16912-1418
Practice Address - Country:US
Practice Address - Phone:570-638-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH074676124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist