MEDICARE: DR. DERREK ARTHUR YELTON 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	122300000X	Dentist	2305	NV

General Provider Information

NPI Number	:	1790715951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERREK ARTHUR YELTON DDS

Provider Business Mailing Address
First Line	:	5660 W. FLAMINGO RD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2312
Country	:	US
Telephone Number	:	702-365-1743
Fax Number	:	702-365-1167

Provider Business Practice Location Address
First Line	:	5660 W. FLAMINGO RD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2312
Country	:	US
Telephone Number	:	702-365-1743
Fax Number	:	702-365-1167

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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