Healthcare Provider Details

I. General information

NPI: 1811130164
Provider Name (Legal Business Name): MATTHEW JORDAN YEZERSKI D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 05/17/2013
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: 615-669-5121
  • Fax: 615-777-3161
Mailing address:
  • Phone: 615-669-5121
  • Fax: 615-777-3161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8592
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9392
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number9392
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: