Healthcare Provider Details

I. General information

NPI: 1588045991
Provider Name (Legal Business Name): LAURA YETTER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 LAURENCE AVE
JACKSON MI
49202-2983
US

IV. Provider business mailing address

1030 LAURENCE AVE
JACKSON MI
49202-2983
US

V. Phone/Fax

Practice location:
  • Phone: 517-879-1746
  • Fax:
Mailing address:
  • Phone: 517-879-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021542
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: