Healthcare Provider Details

I. General information

NPI: 1275587289
Provider Name (Legal Business Name): MICHELLE ANN YEARICK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 FARLEY CIR
LEWISBURG PA
17837-9251
US

IV. Provider business mailing address

217 FARLEY CIR
LEWISBURG PA
17837-9251
US

V. Phone/Fax

Practice location:
  • Phone: 570-524-7318
  • Fax: 570-524-7321
Mailing address:
  • Phone: 570-524-7318
  • Fax: 570-524-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS029601L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: