Organization
MARK K BATESOLE, DDS, MS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK KENNETH BATESOLE DDS, MS (PRESIDENT)
(805) 628-2425
Entity
Organization
Contact information
Practice address
178 S VICTORIA AVE STE C, VENTURA, CA 93003-4369
(805) 628-2425
Mailing address
1055 BANGOR LN, VENTURA, CA 93001-3820
(949) 374-6458
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
08/12/2020
Last updated
08/12/2020
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