Provider Demographics
NPI:1720109911
Name:BATES, JOSEPH LEO (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEO
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 1:222 E WASHINGTON AVE E
Mailing Address - Street 2:
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531
Mailing Address - Country:US
Mailing Address - Phone:641-932-2020
Mailing Address - Fax:641-932-7602
Practice Address - Street 1:222 E WASHINGTON AVE E
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531
Practice Address - Country:US
Practice Address - Phone:641-932-2020
Practice Address - Fax:641-932-7602
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7538 2017794651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1100321Medicaid
IA13786OtherBCBS
IAJ0709335OtherJOHN DEERE