Provider Demographics
NPI:1174976476
Name:JERALD D. BATES, D.D.S., PLLC
Entity type:Organization
Organization Name:JERALD D. BATES, D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-483-1101
Mailing Address - Street 1:13515 NE 175TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8566
Mailing Address - Country:US
Mailing Address - Phone:425-483-1101
Mailing Address - Fax:425-487-6605
Practice Address - Street 1:13515 NE 175TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8566
Practice Address - Country:US
Practice Address - Phone:425-483-1101
Practice Address - Fax:425-487-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental