Provider Demographics
NPI:1225113202
Name:L WAYNE YARBROUGH DMD
Entity Type:Organization
Organization Name:L WAYNE YARBROUGH DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-272-7900
Mailing Address - Street 1:1220 CARMICHAEL WAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-272-7900
Mailing Address - Fax:334-272-7996
Practice Address - Street 1:1220 CARMICHAEL WAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-272-7900
Practice Address - Fax:334-272-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty