Provider Demographics
NPI:1659678936
Name:DONALD YEZERSKI DDS INC
Entity Type:Organization
Organization Name:DONALD YEZERSKI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:YEZERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-234-1810
Mailing Address - Street 1:18660 E, BAGLEY RD.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MIDDLEBURG HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-234-1810
Mailing Address - Fax:440-234-1997
Practice Address - Street 1:7379 PEARL RD.
Practice Address - Street 2:SUITE 2
Practice Address - City:MIDDLEBURG HTS.
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-234-1810
Practice Address - Fax:440-234-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH158391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty