Provider Demographics
NPI:1245301696
Name:YOST, RICHARD KELLEY (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:KELLEY
Last Name:YOST
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 1:161 ASH STREET
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867
Mailing Address - Country:US
Mailing Address - Phone:781-944-7899
Mailing Address - Fax:781-944-5203
Practice Address - Street 1:161 ASH STREET
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867
Practice Address - Country:US
Practice Address - Phone:781-944-7899
Practice Address - Fax:781-944-5203
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0249718Medicaid
MA0249718Medicaid