Provider Demographics
NPI:1164441135
Name:YARBROUGH, DELTON DEE II (DDS)
Entity Type:Individual
Prefix:DR
First Name:DELTON
Middle Name:DEE
Last Name:YARBROUGH
Suffix:II
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 1:1108 W DICKINSON BLVD STE B
Mailing Address - Street 2:P.O. BOX 322
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-4201
Mailing Address - Country:US
Mailing Address - Phone:432-336-8574
Mailing Address - Fax:432-336-8574
Practice Address - Street 1:1108 W DICKINSON BLVD STE B
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-4201
Practice Address - Country:US
Practice Address - Phone:432-336-8574
Practice Address - Fax:432-336-8574
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice