Healthcare Provider Details

I. General information

NPI: 1629089867
Provider Name (Legal Business Name): NATHAN RICHARD YETTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 N. GREENFIELD RD. STE 101
MESA AZ
85205
US

IV. Provider business mailing address

3656 E ANDRE AVE
GILBERT AZ
85297-9155
US

V. Phone/Fax

Practice location:
  • Phone: 480-615-8888
  • Fax: 480-615-8890
Mailing address:
  • Phone: 480-248-6542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD06166
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6616
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: