Provider Demographics
NPI:1760551634
Name:DORRIAN, YVONNE R
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:R
Last Name:DORRIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 W BOY SCOUT BLVD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5727
Mailing Address - Country:US
Mailing Address - Phone:813-288-1999
Mailing Address - Fax:813-288-4500
Practice Address - Street 1:1207 N PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1743
Practice Address - Country:US
Practice Address - Phone:770-631-5062
Practice Address - Fax:770-631-8678
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO128561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080258957BMedicaid