Healthcare Provider Details

I. General information

NPI: 1710470026
Provider Name (Legal Business Name): DANIEL YEAGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W 2ND AVE STE A
DURANGO CO
81301-4607
US

IV. Provider business mailing address

2301 W 2ND AVE STE A
DURANGO CO
81301-4607
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-4740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00203618
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: