Provider Demographics
NPI:1699888420
Name:OATES, DWIGHT ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:ALLEN
Last Name:OATES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 INGRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5466
Mailing Address - Country:US
Mailing Address - Phone:858-273-9435
Mailing Address - Fax:858-273-9435
Practice Address - Street 1:4251 INGRAHAM ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-5466
Practice Address - Country:US
Practice Address - Phone:858-273-9435
Practice Address - Fax:858-273-9435
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191341223G0001X
MN090581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice