Provider Demographics
NPI:1811297393
Name:YEAKLEY, RHETT MATTHEW (DMD)
Entity type:Individual
Prefix:
First Name:RHETT
Middle Name:MATTHEW
Last Name:YEAKLEY
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 1:4530 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-2244
Mailing Address - Country:US
Mailing Address - Phone:530-510-3884
Mailing Address - Fax:
Practice Address - Street 1:1276 WEST ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0415
Practice Address - Country:US
Practice Address - Phone:530-241-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564181223G0001X
IDD-43381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice