Healthcare Provider Details

I. General information

NPI: 1164692091
Provider Name (Legal Business Name): CLYDE YOST DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD STE 400
SAN ANTONIO TX
78211-3793
US

IV. Provider business mailing address

102 PALO ALTO RD, STE 400
SAN ANTONIO TX
78211-3793
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-8770
  • Fax: 210-921-9650
Mailing address:
  • Phone: 210-924-8770
  • Fax: 210-921-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12092
License Number StateTX

VIII. Authorized Official

Name: BETTE J YOST
Title or Position: HYGIENIST
Credential: RDH
Phone: 210-924-8770