Jimmy David Bates, DDS

Individual provider Active NPI General Practice Dentistry · Marshall, TX

NPI 1699888685 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1699888685
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
TX8251 (TX)
Practice address
304 University Ave
Suite 101
Marshall, TX 75670-5210
Phone
(903) 938-5591
Fax
(903) 938-1481
NPI assigned
Aug 16, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
TX8251TXMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X TX8251 TX Yes

Addresses

Primary practice location

304 University Ave
Suite 101
Marshall, TX 75670-5210

Mailing address

304 University Ave
Suite 101
Marshall, TX 75670-5210
Phone (903) 938-5591

Other providers in Marshall, TX

All providers in Marshall, TX · General Practice Dentistry in Texas

Sources for this page

Verify at the official NPI Registry.