Provider Demographics
NPI:1114544772
Name:YATES, PAUL IV (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:YATES
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GATLING AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-2005
Mailing Address - Country:US
Mailing Address - Phone:646-504-4074
Mailing Address - Fax:
Practice Address - Street 1:1118 WOODRUFF RD STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4134
Practice Address - Country:US
Practice Address - Phone:186-425-2393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.9661GD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice