Provider Demographics
NPI:1275587289
Name:YEARICK, MICHELLE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANN
Last Name:YEARICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 FARLEY CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9251
Mailing Address - Country:US
Mailing Address - Phone:570-524-7318
Mailing Address - Fax:570-524-7321
Practice Address - Street 1:217 FARLEY CIR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9251
Practice Address - Country:US
Practice Address - Phone:570-524-7318
Practice Address - Fax:570-524-7321
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029601L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015736170005Medicaid
U65944Medicare UPIN