Provider Demographics
NPI:1265668362
Name:YETERIAN, MASIS JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MASIS
Middle Name:
Last Name:YETERIAN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E PUTNAM AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2734
Mailing Address - Country:US
Mailing Address - Phone:203-869-2884
Mailing Address - Fax:203-618-1213
Practice Address - Street 1:211 E PUTNAM AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2734
Practice Address - Country:US
Practice Address - Phone:203-869-2884
Practice Address - Fax:203-618-1213
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0093901223G0001X
NY0422611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice