Provider Demographics
NPI:1932550597
Name:BATES, TASSANAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:TASSANAI
Middle Name:
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 1:1803 CALVIN CT
Mailing Address - Street 2:APT 8
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-3135
Mailing Address - Country:US
Mailing Address - Phone:319-512-1191
Mailing Address - Fax:
Practice Address - Street 1:1905 N 15TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-7604
Practice Address - Country:US
Practice Address - Phone:515-573-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist