Provider Demographics
NPI:1760547087
Name:BATES, GUY PHILLIP JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:PHILLIP
Last Name:BATES
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 E WOODHURST DR
Mailing Address - Street 2:F-100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4257
Mailing Address - Country:US
Mailing Address - Phone:417-887-3860
Mailing Address - Fax:417-887-7749
Practice Address - Street 1:1200 E WOODHURST DR
Practice Address - Street 2:F-100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4257
Practice Address - Country:US
Practice Address - Phone:417-887-3860
Practice Address - Fax:417-887-7749
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO0119291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice