Provider Demographics
NPI:1366638280
Name:YAUCH, DOUGLAS CORBIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CORBIN
Last Name:YAUCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 CLAREOLA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48632
Mailing Address - Country:US
Mailing Address - Phone:989-544-2824
Mailing Address - Fax:
Practice Address - Street 1:8585 N CROSWELL RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-9210
Practice Address - Country:US
Practice Address - Phone:989-681-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist