MEDICARE: TIANNE YARBROUGH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	34091	TX

General Provider Information

NPI Number	:	1366938466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIANNE YARBROUGH DDS

Provider Business Mailing Address
First Line	:	4111 COLE AVE APT 25
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1533
Country	:	US
Telephone Number	:	806-367-8115
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 HERITAGE TRACE PKWY STE 212
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8902
Country	:	US
Telephone Number	:	817-482-1400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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