Provider Demographics
NPI:1194189795
Name:BATES, PHILIP HOLDEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:HOLDEN
Last Name:BATES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 FURLONG DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2341
Mailing Address - Country:US
Mailing Address - Phone:865-680-3341
Mailing Address - Fax:
Practice Address - Street 1:1053 HUNTERS XING
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-1854
Practice Address - Country:US
Practice Address - Phone:865-223-6705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY97581223G0001X
TNDS00000109441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice