Provider Demographics
NPI:1962649327
Name:YASNER, MICHAEL D (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:YASNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 BRACE RD.
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-795-8020
Mailing Address - Fax:856-795-9785
Practice Address - Street 1:1416 BRACE RD.
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:856-795-8020
Practice Address - Fax:856-795-9785
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ141431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
11133OtherDELTA