Provider Demographics
NPI:1811130164
Name:YEZERSKI, MATTHEW JORDAN (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JORDAN
Last Name:YEZERSKI
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 1:509 NEW HIGHWAY 96 W
Mailing Address - Street 2:SUITE #100
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2556
Mailing Address - Country:US
Mailing Address - Phone:615-669-5121
Mailing Address - Fax:615-777-3161
Practice Address - Street 1:509 NEW HIGHWAY 96 W
Practice Address - Street 2:SUITE #100
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2556
Practice Address - Country:US
Practice Address - Phone:615-669-5121
Practice Address - Fax:615-777-3161
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8592122300000X
TN9392122300000X, 1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No122300000XDental ProvidersDentist