Provider Demographics
NPI:1689754293
Name:BATES, JOHN LEROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEROY
Last Name:BATES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:LEE
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
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 1:341 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5112
Practice Address - Country:US
Practice Address - Phone:828-433-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44651223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90489OtherBCBS NC
U35470Medicare UPIN