Provider Demographics
NPI:1265201057
Name:BATES, ELLEIGH JAE (DDS)
Entity type:Individual
Prefix:
First Name:ELLEIGH
Middle Name:JAE
Last Name:BATES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 E 54TH LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-9158
Mailing Address - Country:US
Mailing Address - Phone:360-244-3765
Mailing Address - Fax:
Practice Address - Street 1:3615 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2624
Practice Address - Country:US
Practice Address - Phone:509-456-8676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61457306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist