Provider Demographics
NPI:1164692091
Name:CLYDE YOST DDS PA
Entity Type:Organization
Organization Name:CLYDE YOST DDS PA
Other - Org Name:YOST PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOST
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:210-924-8770
Mailing Address - Street 1:102 PALO ALTO RD, STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-3793
Mailing Address - Country:US
Mailing Address - Phone:210-924-8770
Mailing Address - Fax:210-921-9650
Practice Address - Street 1:102 PALO ALTO RD STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3793
Practice Address - Country:US
Practice Address - Phone:210-924-8770
Practice Address - Fax:210-921-9650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty