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General NPI Number Information
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NPI Number | 1003476565
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Entity Type | Individual
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Provider Name | ADAM YAZBACK DDS
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Gender | Male
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 1050 N MONROE ST
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City | MONROE
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State | MI
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Zip | 48162-3113
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Country | US
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Telephone | 734-243-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 4853 WESTLAND ST
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City | DEARBORN
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State | MI
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Zip | 48126-4112
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Country | US
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Telephone | 313-399-5088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901600142
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License Number State | MI
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