=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205857570
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICHOLAS CHRIST YIANNIOS D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 07/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3718 S PINNACLE HILLS PKWY
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72758-8897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-876-8000
-----------------------------------------------------
Fax | 479-876-8878
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3718 S PINNACLE HILLS PKWY
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72758-8897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-876-8000
-----------------------------------------------------
Fax | 479-876-8878
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 015680
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 3979
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------