Provider Demographics
NPI:1154483162
Name:YARBROUGH, JAYSEN ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAYSEN
Middle Name:ALAN
Last Name:YARBROUGH
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 1:1722 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4542
Mailing Address - Country:US
Mailing Address - Phone:931-645-2749
Mailing Address - Fax:931-645-2778
Practice Address - Street 1:1722 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4542
Practice Address - Country:US
Practice Address - Phone:931-645-2749
Practice Address - Fax:931-645-2778
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS000068991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice