Provider Demographics
NPI:1114937521
Name:YADAV, YATI K (DDS)
Entity Type:Individual
Prefix:DR
First Name:YATI
Middle Name:K
Last Name:YADAV
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 1:8390 W CACTUS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5206
Mailing Address - Country:US
Mailing Address - Phone:623-878-3300
Mailing Address - Fax:623-878-3302
Practice Address - Street 1:8390 W CACTUS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5206
Practice Address - Country:US
Practice Address - Phone:623-878-3300
Practice Address - Fax:623-878-3302
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD53871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice