Provider Demographics
NPI:1285770552
Name:YEAGER, STANLEY G (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:G
Last Name:YEAGER
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9223
Mailing Address - Country:US
Mailing Address - Phone:973-335-9432
Mailing Address - Fax:973-335-3504
Practice Address - Street 1:112 MAIN RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9223
Practice Address - Country:US
Practice Address - Phone:973-335-9432
Practice Address - Fax:973-335-3504
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1009544001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice