Healthcare Provider Details

I. General information

NPI: 1467522128
Provider Name (Legal Business Name): DONALD YEZERSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7379 PEARL RD SUITE 2
CLEVELAND OH
44130-4898
US

IV. Provider business mailing address

7379 PEARL RD SUITE 2
CLEVELAND OH
44130-4898
US

V. Phone/Fax

Practice location:
  • Phone: 440-234-1810
  • Fax: 440-234-1997
Mailing address:
  • Phone: 440-234-1810
  • Fax: 440-234-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15839
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number15839
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: