Healthcare Provider Details

I. General information

NPI: 1144278961
Provider Name (Legal Business Name): ROBERT W YATES DOS TROY W YATES DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6936 SO 2475 EAST PROMENADE DR
SALT LAKE CITY UT
84121
US

IV. Provider business mailing address

6936 SO 2475 EAST PROMENADE DR
SALT LAKE CITY UT
84121
US

V. Phone/Fax

Practice location:
  • Phone: 801-943-4577
  • Fax: 801-943-4577
Mailing address:
  • Phone: 801-943-4577
  • Fax: 801-943-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberE85787
License Number StateUT

VIII. Authorized Official

Name: ROBERT W YATES
Title or Position: PARTNER
Credential: DDS
Phone: 801-943-4577