Provider Demographics
NPI:1992859771
Name:BATES, RICHARD W (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:BATES
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 1:3610 BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1329
Mailing Address - Country:US
Mailing Address - Phone:804-526-0937
Mailing Address - Fax:804-520-7582
Practice Address - Street 1:3610 BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1329
Practice Address - Country:US
Practice Address - Phone:804-526-0937
Practice Address - Fax:804-520-7582
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA63861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541336513OtherTAX ID NUMBER