MEDICARE: YEPES DDS LLC

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1962173575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YEPES DDS LLC

Provider Business Mailing Address
First Line	:	13760 LAKERIDGE DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-7608
Country	:	US
Telephone Number	:	317-597-0184
Fax Number	:	317-932-5978

Provider Business Practice Location Address
First Line	:	13760 LAKERIDGE DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-7608
Country	:	US
Telephone Number	:	317-597-0184
Fax Number	:	317-932-5978

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	ALONDRA CAMACHO
Credential	:
Telephone Number	:	317-597-0184

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	09/23/2021

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Directions to “YEPES DDS LLC ” Practice Location

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