Provider Demographics
NPI:1154913176
Name:WILLIAM YODER DMD PLLC
Entity type:Organization
Organization Name:WILLIAM YODER DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ERVIN
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-327-8286
Mailing Address - Street 1:340 THOMAS MORE PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 THOMAS MORE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5101
Practice Address - Country:US
Practice Address - Phone:859-327-8286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9344OtherKENTUCKY STATE DENTAL LICENSE