Provider Demographics
NPI:1306041504
Name:DAN R YARBROUGH,D.M.D.
Entity type:Organization
Organization Name:DAN R YARBROUGH,D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-549-7422
Mailing Address - Street 1:100 COMMERCE ST # A
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2943
Mailing Address - Country:US
Mailing Address - Phone:843-549-7422
Mailing Address - Fax:843-549-6017
Practice Address - Street 1:100 COMMERCE ST # A
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2943
Practice Address - Country:US
Practice Address - Phone:843-549-7422
Practice Address - Fax:843-549-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9892Medicaid