Individual
DR. SCOTT ERIC TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
707 N MICHIGAN ST, SOUTH BEND, IN 46601-1067
(574) 289-0080
(812) 323-9701
Mailing address
707 N MICHIGAN ST, SOUTH BEND, IN 46601-1067
(812) 323-9700
(812) 323-9701
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
IN12010196A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200494170
—
IN
Enumeration date
09/20/2006
Last updated
04/18/2025
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