Provider Demographics
NPI:1437298122
Name:YORTY, JACK S (DENTIST)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:S
Last Name:YORTY
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 ELM DRIVE
Mailing Address - Street 2:STEVEN J PINELLI DMD AND ASSOC
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370
Mailing Address - Country:US
Mailing Address - Phone:724-852-2336
Mailing Address - Fax:724-852-4049
Practice Address - Street 1:232 ELM DRIVE
Practice Address - Street 2:STEVEN J PINELLI DMD AND ASSOC
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370
Practice Address - Country:US
Practice Address - Phone:724-852-2336
Practice Address - Fax:724-852-4049
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020187L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice