Provider Demographics
NPI:1336322858
Name:JOHN LEE BATES, D.D.S.,P.A.
Entity Type:Organization
Organization Name:JOHN LEE BATES, D.D.S.,P.A.
Other - Org Name:JOHN LEE BATES, D.D.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-651-7908
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:JONAS RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28641-0007
Mailing Address - Country:US
Mailing Address - Phone:704-651-7908
Mailing Address - Fax:
Practice Address - Street 1:504 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5761
Practice Address - Country:US
Practice Address - Phone:828-438-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4465261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90489OtherBCBS OF NC
NCU35470Medicaid