Provider Demographics
NPI:1982910899
Name:BATES, CORINNE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:A
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 1:3955 BAYLESS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-1439
Mailing Address - Country:US
Mailing Address - Phone:314-638-4190
Mailing Address - Fax:314-638-3900
Practice Address - Street 1:3955 BAYLESS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-1439
Practice Address - Country:US
Practice Address - Phone:314-638-4190
Practice Address - Fax:314-638-3900
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100302661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice