Healthcare Provider Details

I. General information

NPI: 1437342649
Provider Name (Legal Business Name): JUSTIN HERMANN YEATES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 CONTINENTAL PL SUITE 9
MOUNT VERNON WA
98273-5649
US

IV. Provider business mailing address

2017 CONTINENTAL PL SUITE 9
MOUNT VERNON WA
98273-5649
US

V. Phone/Fax

Practice location:
  • Phone: 360-424-3133
  • Fax:
Mailing address:
  • Phone: 360-424-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00011024
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: