Provider Demographics
NPI:1659550655
Name:CATES, AMY C (DMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:CATES
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 1:11 BUFORD VILLAGE WAY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8845
Mailing Address - Country:US
Mailing Address - Phone:678-765-8011
Mailing Address - Fax:
Practice Address - Street 1:11 BUFORD VILLAGE WAY
Practice Address - Street 2:SUITE 111
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8845
Practice Address - Country:US
Practice Address - Phone:678-765-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0118551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice