Healthcare Provider Details

I. General information

NPI: 1639162902
Provider Name (Legal Business Name): JOHN J YUROSKO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SHAMROCK BLVD
VENICE FL
34293-1630
US

IV. Provider business mailing address

123 SHAMROCK BLVD
VENICE FL
34293-1630
US

V. Phone/Fax

Practice location:
  • Phone: 941-493-3352
  • Fax: 941-497-1140
Mailing address:
  • Phone: 941-493-3352
  • Fax: 941-497-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0006192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: