Provider Demographics
NPI:1093765893
Name:YACKO, ROBERT B (DDS;PC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:YACKO
Suffix:
Gender:M
Credentials:DDS;PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 W PEORIA AVE STE 134
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-9320
Mailing Address - Country:US
Mailing Address - Phone:623-878-3722
Mailing Address - Fax:623-486-8380
Practice Address - Street 1:6750 W PEORIA AVE STE 134
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-9320
Practice Address - Country:US
Practice Address - Phone:623-878-3722
Practice Address - Fax:623-486-8380
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice