Provider Demographics
NPI:1104219344
Name:OASIS FAMILY DENTAL SPA, LLC
Entity Type:Organization
Organization Name:OASIS FAMILY DENTAL SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-427-0070
Mailing Address - Street 1:1096 W INDIANTOWN RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6800
Mailing Address - Country:US
Mailing Address - Phone:561-427-0070
Mailing Address - Fax:561-427-0435
Practice Address - Street 1:1096 W INDIANTOWN RD
Practice Address - Street 2:SUITE #200
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6800
Practice Address - Country:US
Practice Address - Phone:561-427-0070
Practice Address - Fax:561-427-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty