Provider Demographics
NPI:1326325879
Name:JAMES M YASSICK DDS PC
Entity Type:Organization
Organization Name:JAMES M YASSICK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:YASSICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-694-2409
Mailing Address - Street 1:13012 OLD GLENN HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7568
Mailing Address - Country:US
Mailing Address - Phone:907-694-2409
Mailing Address - Fax:907-694-2451
Practice Address - Street 1:13012 OLD GLENN HWY STE 102
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7568
Practice Address - Country:US
Practice Address - Phone:907-694-2409
Practice Address - Fax:907-694-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKD 386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty