Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D11977 | MN |
NPI | 1023172657 |
---|---|
Provider Name | Dr. Sean Patrick Bates |
First Address | Hugo, MN 55038 |
Second Address | Hugo, MN 55038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 08/07/2007 |