Provider Demographics
NPI:1881951291
Name:JOSEPH W. YERGER
Entity type:Organization
Organization Name:JOSEPH W. YERGER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:YERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-574-0765
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71284-0709
Mailing Address - Country:US
Mailing Address - Phone:318-574-0765
Mailing Address - Fax:318-574-3464
Practice Address - Street 1:1403 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-5513
Practice Address - Country:US
Practice Address - Phone:318-574-0765
Practice Address - Fax:318-574-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1820172Medicaid