Provider Demographics
NPI:1184819500
Name:YATES, EDGAR W JR (DDS)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:W
Last Name:YATES
Suffix:JR
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 1:2900 DELK RD SE
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5320
Mailing Address - Country:US
Mailing Address - Phone:770-951-1133
Mailing Address - Fax:770-951-9387
Practice Address - Street 1:2900 DELK RD SE
Practice Address - Street 2:SUITE 1450
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5320
Practice Address - Country:US
Practice Address - Phone:770-951-1133
Practice Address - Fax:770-951-9387
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist