Provider Demographics
NPI:1417573825
Name:BATES, WILLIAM (DMD, MS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BATES
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SUNBELT DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-0003
Mailing Address - Country:US
Mailing Address - Phone:256-520-8968
Mailing Address - Fax:
Practice Address - Street 1:2826 LAKESHORE PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-5500
Practice Address - Country:US
Practice Address - Phone:256-520-8968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.0006768-C11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics