Provider Demographics
NPI:1083975304
Name:RHETT YEAKLEY DMD, PLLC
Entity Type:Organization
Organization Name:RHETT YEAKLEY DMD, PLLC
Other - Org Name:TREASURE VALLEY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:YEAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:530-510-3884
Mailing Address - Street 1:1570 E HERITAGE PARK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5886
Mailing Address - Country:US
Mailing Address - Phone:208-884-8066
Mailing Address - Fax:208-884-4809
Practice Address - Street 1:1570 E HERITAGE PARK ST STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5886
Practice Address - Country:US
Practice Address - Phone:208-884-8066
Practice Address - Fax:208-884-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD43381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty