Provider Demographics
NPI:1063817153
Name:MICHELLE A. YEARICK, D.D.S., P.C.
Entity Type:Organization
Organization Name:MICHELLE A. YEARICK, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YEARICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-524-7318
Mailing Address - Street 1:217 FARLEY CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9251
Mailing Address - Country:US
Mailing Address - Phone:570-524-7318
Mailing Address - Fax:570-524-7321
Practice Address - Street 1:217 FARLEY CIR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9251
Practice Address - Country:US
Practice Address - Phone:570-524-7318
Practice Address - Fax:570-524-7321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029601L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015736170005Medicaid