Provider Demographics
NPI:1023172657
Name:BATES, SEAN PATRICK (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PATRICK
Last Name:BATES
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14755 VICTOR HUGO BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038
Mailing Address - Country:US
Mailing Address - Phone:651-429-0094
Mailing Address - Fax:651-426-8706
Practice Address - Street 1:14755 VICTOR HUGO BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038
Practice Address - Country:US
Practice Address - Phone:651-429-0094
Practice Address - Fax:651-426-8706
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND119771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics