Provider Demographics
NPI:1619280328
Name:AL-YAKOUBI, YASER
Entity Type:Individual
Prefix:DR
First Name:YASER
Middle Name:
Last Name:AL-YAKOUBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 DAPPLE DR
Mailing Address - Street 2:APT 1226
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6699
Mailing Address - Country:US
Mailing Address - Phone:317-748-6676
Mailing Address - Fax:
Practice Address - Street 1:6302 MEADOWBROOK DR
Practice Address - Street 2:SUITE#112
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-5162
Practice Address - Country:US
Practice Address - Phone:817-446-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246411223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics