MEDICARE: DR. YASER AL-YAKOUBI

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	1223P0700X	Prosthodontics	24641	TX

General Provider Information

NPI Number	:	1619280328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YASER AL-YAKOUBI

Provider Business Mailing Address
First Line	:	4450 DAPPLE DR
Second Line	:	APT 1226
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6699
Country	:	US
Telephone Number	:	317-748-6676
Fax Number	:

Provider Business Practice Location Address
First Line	:	6302 MEADOWBROOK DR
Second Line	:	SUITE#112
City	:	FORT WORTH
State	:	TX
Zip	:	76112-5162
Country	:	US
Telephone Number	:	817-446-0800
Fax Number	:

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

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	07/22/2010

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