Provider Demographics
NPI:1235251570
Name:YAERGER DENTAL
Entity Type:Organization
Organization Name:YAERGER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-758-0022
Mailing Address - Street 1:1015 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-4705
Mailing Address - Country:US
Mailing Address - Phone:918-758-0022
Mailing Address - Fax:918-756-2046
Practice Address - Street 1:1015 E 6TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4705
Practice Address - Country:US
Practice Address - Phone:918-758-0022
Practice Address - Fax:918-756-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200058840AMedicaid