Provider Demographics
NPI:1730253576
Name:BATES, CAROYLN COUSINS (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROYLN
Middle Name:COUSINS
Last Name:BATES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E KEMPER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3224
Mailing Address - Country:US
Mailing Address - Phone:513-642-0002
Mailing Address - Fax:513-551-5017
Practice Address - Street 1:35 E KEMPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3224
Practice Address - Country:US
Practice Address - Phone:513-642-0002
Practice Address - Fax:513-551-5017
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30. 017027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0001928OtherASSURANT
OH300056109OtherCARESOURCE
OH113300OtherAETNA DMO
OH0479138Medicaid