Individual
MRS. BRENDA J BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRDH
Contact information
Practice address
619 S MARION AVE, LAKE CITY, FL 32025-5808
(386) 155-3016
Mailing address
PO BOX 739, BRANFORD, FL 32008-0739
(386) 364-8526
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
14857
FL
Other
Enumeration date
05/13/2022
Last updated
05/13/2022
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