1164692091 NPI number — CLYDE YOST DDS PA

Table of content: (NPI 1164692091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164692091 NPI number — CLYDE YOST DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLYDE YOST DDS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
YOST PEDIATRIC DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164692091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 PALO ALTO RD, STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78211-3793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-924-8770
Provider Business Mailing Address Fax Number:
210-921-9650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 PALO ALTO RD STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78211-3793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-924-8770
Provider Business Practice Location Address Fax Number:
210-921-9650
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
YOST
Authorized Official First Name:
BETTE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
HYGIENIST
Authorized Official Telephone Number:
210-924-8770

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  12092 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com