Healthcare Provider Details

I. General information

NPI: 1922165059
Provider Name (Legal Business Name): MERVYN YANKELSON BDS.,MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 W GATE BLVD SUITE 136
AUSTIN TX
78745-4883
US

IV. Provider business mailing address

6310 MAURY HOLW 136
AUSTIN TX
78750-8257
US

V. Phone/Fax

Practice location:
  • Phone: 512-442-3480
  • Fax: 512-442-7274
Mailing address:
  • Phone: 512-346-9621
  • Fax: 512-346-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number12924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: