Provider Demographics
NPI:1952366155
Name:BATES, CAROL STEWART (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:STEWART
Last Name:BATES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:MARIE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 100425
Mailing Address - Street 2:1600 SW ARCHER ROAD, D4-4
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0425
Mailing Address - Country:US
Mailing Address - Phone:352-273-5380
Mailing Address - Fax:352-392-7402
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-5380
Practice Address - Fax:352-392-3070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTP0971223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL67409ZMedicare ID - Type Unspecified
FLT84409Medicare UPIN