Provider Demographics
NPI:1407415714
Name:YATES, BRYCE JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:JAMES
Last Name:YATES
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 1:1690 W 4200 N
Mailing Address - Street 2:
Mailing Address - City:HELPER
Mailing Address - State:UT
Mailing Address - Zip Code:84526-2110
Mailing Address - Country:US
Mailing Address - Phone:435-465-8758
Mailing Address - Fax:
Practice Address - Street 1:230 N FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4205
Practice Address - Country:US
Practice Address - Phone:435-637-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11303340-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist