MEDICARE: DR. JOHN M YANCEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1235143934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN M YANCEY DDS

Provider Business Mailing Address
First Line	:	1033 S OAK ST
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3836
Country	:	US
Telephone Number	:	630-231-1090
Fax Number	:	630-231-1869

Provider Business Practice Location Address
First Line	:	1033 S OAK ST
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3836
Country	:	US
Telephone Number	:	630-231-1090
Fax Number	:	630-231-1869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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