Healthcare Provider Details

I. General information

NPI: 1932115037
Provider Name (Legal Business Name): MICHAEL ANDREW YACKO II D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S 160
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

1010 PERKINS LN
FRANKLIN TN
37069-4734
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-5321
  • Fax: 615-321-6331
Mailing address:
  • Phone: 615-790-9592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number328371
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: