Provider Demographics
NPI:1194783886
Name:YATES, MARK PAUL (DMD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:PAUL
Last Name:YATES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E CAREFREE HWY
Mailing Address - Street 2:PMB 834
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:623-465-2231
Mailing Address - Fax:
Practice Address - Street 1:11100 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363
Practice Address - Country:US
Practice Address - Phone:623-974-5629
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist