Provider Demographics
NPI:1326103607
Name:BATES, BRUCE DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DEAN
Last Name:BATES
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 1:2575 HAMLINE AVE N
Mailing Address - Street 2:SUITE F
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-636-2373
Mailing Address - Fax:651-636-2374
Practice Address - Street 1:2575 HAMLINE AVE N
Practice Address - Street 2:SUITE F
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-636-2373
Practice Address - Fax:651-636-2374
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND7927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist