Provider Demographics
NPI:1225870074
Name:BATES, SYDNEY NICOLE (DMD)
Entity type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:NICOLE
Last Name:BATES
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 1:8823 GOODBYS EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4605
Mailing Address - Country:US
Mailing Address - Phone:904-762-8090
Mailing Address - Fax:
Practice Address - Street 1:8823 GOODBYS EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4605
Practice Address - Country:US
Practice Address - Phone:904-762-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN292331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty