Provider Demographics
NPI:1134200421
Name:JOEL W. YATES JR. D.D.S. P.L.L.C
Entity type:Organization
Organization Name:JOEL W. YATES JR. D.D.S. P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:YATES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-846-2323
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-0499
Mailing Address - Country:US
Mailing Address - Phone:336-846-2323
Mailing Address - Fax:336-846-5635
Practice Address - Street 1:525 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-8991
Practice Address - Country:US
Practice Address - Phone:336-846-2323
Practice Address - Fax:336-846-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty