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General NPI Number Information
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NPI Number | 1811130164
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Entity Type | Individual
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Provider Name | MATTHEW JORDAN YEZERSKI D.M.D
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Gender | Male
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Dates
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Enumeration Date | 04/16/2009
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 509 NEW HIGHWAY 96 W SUITE #100
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City | FRANKLIN
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State | TN
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Zip | 37064-2556
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Country | US
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Telephone | 615-669-5121
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Fax | 615-777-3161
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Provider Business Mailing Address
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Address Line | 509 NEW HIGHWAY 96 W SUITE #100
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City | FRANKLIN
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State | TN
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Zip | 37064-2556
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Country | US
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Telephone | 615-669-5121
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Fax | 615-777-3161
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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 | 8592
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9392
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 9392
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License Number State | TN
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