Provider Demographics
NPI:1629089867
Name:YETTER, NATHAN RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:RICHARD
Last Name:YETTER
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 1:3656 E ANDRE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9155
Mailing Address - Country:US
Mailing Address - Phone:480-248-6542
Mailing Address - Fax:
Practice Address - Street 1:1249 N. GREENFIELD RD. STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:480-615-8888
Practice Address - Fax:480-615-8890
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist