Provider Demographics
NPI:1598823148
Name:YATSONSKY, THOMAS MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:YATSONSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RURAL ROUTE 1 BOX 476
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-9732
Mailing Address - Country:US
Mailing Address - Phone:570-685-7170
Mailing Address - Fax:570-685-7170
Practice Address - Street 1:RURAL ROUTE 1 BOX 476
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-9732
Practice Address - Country:US
Practice Address - Phone:570-685-7170
Practice Address - Fax:570-685-7170
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026873L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice