Provider Demographics
NPI:1255907515
Name:BATES, MASON THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:MASON
Middle Name:THOMAS
Last Name:BATES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1925 THOMSON DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1008
Mailing Address - Country:US
Mailing Address - Phone:434-846-4014
Mailing Address - Fax:434-846-2467
Practice Address - Street 1:1925 THOMSON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1008
Practice Address - Country:US
Practice Address - Phone:434-846-4014
Practice Address - Fax:434-846-2467
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04014173601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics