Provider Demographics
NPI:1639457468
Name:JUSTIN H YEATES DDS PLLC
Entity Type:Organization
Organization Name:JUSTIN H YEATES DDS PLLC
Other - Org Name:YEATES FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER.OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:HERMANN
Authorized Official - Last Name:YEATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-855-1689
Mailing Address - Street 1:825 MURDOCK ST
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1451
Mailing Address - Country:US
Mailing Address - Phone:360-855-1689
Mailing Address - Fax:360-855-1689
Practice Address - Street 1:825 MURDOCK ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1451
Practice Address - Country:US
Practice Address - Phone:360-855-1689
Practice Address - Fax:360-855-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE11024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty