Provider Demographics
NPI:1386636504
Name:YEARY, JAMES R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:YEARY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:R
Other - Last Name:YEARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PC
Mailing Address - Street 1:801 WALL ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069
Mailing Address - Country:US
Mailing Address - Phone:405-329-7171
Mailing Address - Fax:405-321-7540
Practice Address - Street 1:801 WALL ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6303
Practice Address - Country:US
Practice Address - Phone:405-329-7171
Practice Address - Fax:405-321-7540
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100112740AMedicaid