Provider Demographics
NPI:1659305639
Name:YAEGER, JOHN HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAROLD
Last Name:YAEGER
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 1:7490 E FISH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2736
Mailing Address - Country:US
Mailing Address - Phone:763-420-4235
Mailing Address - Fax:763-420-5488
Practice Address - Street 1:7490 E FISH LAKE RD
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2736
Practice Address - Country:US
Practice Address - Phone:763-420-4235
Practice Address - Fax:763-420-5488
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN89261223G0001X
MND8926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN665818100OtherWELFARE NUMBER
MN665818100OtherWELFARE NUMBER