Provider Demographics
NPI:1699845263
Name:OATES, HENRY CYRUS (DDS)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:CYRUS
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 1:3957 N MULFORD RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8004
Mailing Address - Country:US
Mailing Address - Phone:815-637-6400
Mailing Address - Fax:815-637-6477
Practice Address - Street 1:3957 N MULFORD RD STE A
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8004
Practice Address - Country:US
Practice Address - Phone:815-637-6400
Practice Address - Fax:815-637-6477
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0165791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice