Healthcare Provider Details

I. General information

NPI: 1710070263
Provider Name (Legal Business Name): KEITH WILLIAM YORKO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LONG POND RD SUITE 115
ROCHESTER NY
14626-1177
US

IV. Provider business mailing address

1100 LONG POND RD SUITE 115
ROCHESTER NY
14626-1177
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-7790
  • Fax:
Mailing address:
  • Phone: 585-225-7790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number044956
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: