Provider Demographics
NPI:1821663238
Name:BATES, JOHN CLAYTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLAYTON
Last Name:BATES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PHEASANT CT
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3277
Mailing Address - Country:US
Mailing Address - Phone:803-517-3523
Mailing Address - Fax:
Practice Address - Street 1:504 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3709
Practice Address - Country:US
Practice Address - Phone:803-279-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist