Individual provider · NPI-1

Dr. Travis Carl Bates, D.D.S.

Dentist, General Practice · Shawnee, OK

NPI number1124511506
StatusActive
Last updated in NPPESJun 11, 2018

Details

NPI
1124511506
Entity type
Individual (NPI-1)
Name
Dr. Travis Carl Bates
Credential
D.D.S.
Sex
Male
Sole proprietor
No
Enumeration date
Jun 11, 2018
Last updated
Jun 11, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice7032OKYes

Practice location

2307 Gordon Cooper Dr
Shawnee, OK 74801-9007

Phone 405-273-6337

Mailing address

8619 E Reno Ave Apt 3
Midwest City, OK 73110-6963

Phone 580-212-5410

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