Provider Demographics
NPI:1083721914
Name:BATES, WILLLIAM SCOTT (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:WILLLIAM
Middle Name:SCOTT
Last Name:BATES
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27534 TWIN PEAK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2010
Mailing Address - Country:US
Mailing Address - Phone:210-494-4606
Mailing Address - Fax:
Practice Address - Street 1:17006 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2231
Practice Address - Country:US
Practice Address - Phone:210-494-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX805044OtherPROVIDER #