Provider Demographics
NPI:1568506095
Name:OATES, FREDERICK BURNELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:BURNELL
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 1:106 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1030
Mailing Address - Country:US
Mailing Address - Phone:608-375-2814
Mailing Address - Fax:608-375-2383
Practice Address - Street 1:110 S OHIO ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1642
Practice Address - Country:US
Practice Address - Phone:608-326-8458
Practice Address - Fax:608-326-4067
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50009361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice