Provider Demographics
NPI:1609949262
Name:BATES, STEVEN RUSSELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RUSSELL
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 1:140 BEAVERTON CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-6011
Mailing Address - Country:US
Mailing Address - Phone:843-873-7005
Mailing Address - Fax:
Practice Address - Street 1:6518 DORCHESTER RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-5100
Practice Address - Country:US
Practice Address - Phone:843-767-1809
Practice Address - Fax:843-767-9244
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice