Provider Demographics
NPI:1710222666
Name:JOSEPH A. YALE, DDS, LLC
Entity Type:Organization
Organization Name:JOSEPH A. YALE, DDS, LLC
Other - Org Name:YALE PEDIATRIC DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:YALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-664-2646
Mailing Address - Street 1:348 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4721
Mailing Address - Country:US
Mailing Address - Phone:225-664-2646
Mailing Address - Fax:225-664-2640
Practice Address - Street 1:348 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4721
Practice Address - Country:US
Practice Address - Phone:225-664-2646
Practice Address - Fax:225-664-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1856754Medicaid