Provider Demographics
NPI:1841864469
Name:BATES, MACKENZIE (DDS, MSD)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 BUSY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4066
Mailing Address - Country:US
Mailing Address - Phone:804-215-8600
Mailing Address - Fax:
Practice Address - Street 1:11600 BUSY ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4066
Practice Address - Country:US
Practice Address - Phone:804-215-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014174951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry