Provider Demographics
NPI:1689768137
Name:BATESOLE, MARK K (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
Last Name:BATESOLE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 BANGOR LN
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3820
Mailing Address - Country:US
Mailing Address - Phone:949-374-6458
Mailing Address - Fax:
Practice Address - Street 1:178 S VICTORIA AVE STE C
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4369
Practice Address - Country:US
Practice Address - Phone:805-628-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics