Provider Demographics
NPI:1063667590
Name:YARRIS, DOUGLAS MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:YARRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:CA
Mailing Address - Zip Code:94525-1111
Mailing Address - Country:US
Mailing Address - Phone:510-787-1471
Mailing Address - Fax:510-787-3018
Practice Address - Street 1:716 2ND AVE
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:CA
Practice Address - Zip Code:94525-1111
Practice Address - Country:US
Practice Address - Phone:510-787-1471
Practice Address - Fax:510-787-3018
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0318871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice