MEDICARE: LINDSAY C YANCEY JR DDS, PC

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	122300000X	Dentist	4458	NC

General Provider Information

NPI Number	:	1679904304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDSAY C YANCEY JR DDS, PC

Provider Business Mailing Address
First Line	:	481 SHEPHERD ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1627
Country	:	US
Telephone Number	:	336-768-8850
Fax Number	:	336-768-0135

Provider Business Practice Location Address
First Line	:	481 SHEPHERD ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1627
Country	:	US
Telephone Number	:	336-768-8850
Fax Number	:	336-768-0135

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LINDSAY C YANCEY JR.
Credential	:	DDS
Telephone Number	:	336-768-8850

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	12/05/2013

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