Provider Demographics
NPI:1124335468
Name:ROBERT W. YATES, DDS, TROY W. YATES, DDS, PC
Entity type:Organization
Organization Name:ROBERT W. YATES, DDS, TROY W. YATES, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-943-4577
Mailing Address - Street 1:6936 SO. PROMENADE DR.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121
Mailing Address - Country:US
Mailing Address - Phone:801-943-4577
Mailing Address - Fax:801-943-4577
Practice Address - Street 1:6936 SO. PROMENADE DR.
Practice Address - Street 2:SUITE 202
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-943-4577
Practice Address - Fax:801-943-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT128081-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty