Provider Demographics
NPI:1215750880
Name:BATES, DAPHNE (RDH)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
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 1:205 NAPOLEON PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-1518
Mailing Address - Country:US
Mailing Address - Phone:901-340-1657
Mailing Address - Fax:
Practice Address - Street 1:1010 JUNE RD STE 105
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3722
Practice Address - Country:US
Practice Address - Phone:901-761-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9103124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist