Provider Demographics
NPI:1922165059
Name:YANKELSON, MERVYN (BDS,MSC)
Entity Type:Individual
Prefix:DR
First Name:MERVYN
Middle Name:
Last Name:YANKELSON
Suffix:
Gender:M
Credentials:BDS,MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 MAURY HOLW
Mailing Address - Street 2:136
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8257
Mailing Address - Country:US
Mailing Address - Phone:512-346-9621
Mailing Address - Fax:512-346-7206
Practice Address - Street 1:6800 W GATE BLVD
Practice Address - Street 2:SUITE 136
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4883
Practice Address - Country:US
Practice Address - Phone:512-442-3480
Practice Address - Fax:512-442-7274
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129241223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics