Healthcare Provider Details

I. General information

NPI: 1346401874
Provider Name (Legal Business Name): JOHN ERIC YEZERSKI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 NEW HIGHWAY 96 W SUITE 100
FRANKLIN TN
37064-2556
US

IV. Provider business mailing address

509 NEW HIGHWAY 96 W SUITE 100
FRANKLIN TN
37064-2556
US

V. Phone/Fax

Practice location:
  • Phone: 615-591-8880
  • Fax: 615-591-8827
Mailing address:
  • Phone: 615-591-8880
  • Fax: 615-591-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8826
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: