Provider Demographics
NPI:1679682405
Name:DR PAUL R YEAGER DDS INC
Entity Type:Organization
Organization Name:DR PAUL R YEAGER DDS INC
Other - Org Name:PAUL R YEAGER DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:YEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-542-7295
Mailing Address - Street 1:2798 YULUPA AVE #2
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-542-7295
Mailing Address - Fax:707-542-9157
Practice Address - Street 1:2798 YULUPA AVE #2
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-542-7295
Practice Address - Fax:707-542-9157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty