Provider Demographics
NPI:1093404493
Name:YATES, ANNA O'BRIEN (DMD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:O'BRIEN
Last Name:YATES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-8968
Mailing Address - Country:US
Mailing Address - Phone:910-893-1096
Mailing Address - Fax:910-814-1559
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-8968
Practice Address - Country:US
Practice Address - Phone:910-893-1096
Practice Address - Fax:910-814-1559
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133571223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice