Healthcare Provider Details

I. General information

NPI: 1255622635
Provider Name (Legal Business Name): JOHN RUSSELL YANCEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8683 E LINCOLN AVE STE 130
LONE TREE CO
80124-9812
US

IV. Provider business mailing address

12548 N 4TH ST
PARKER CO
80134-9458
US

V. Phone/Fax

Practice location:
  • Phone: 317-459-0738
  • Fax:
Mailing address:
  • Phone: 317-459-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8020326-9924
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDEN.00203857
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: