Provider Demographics
NPI:1427059666
Name:YEATS, DAVID J (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:YEATS
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 1:5305 S 96TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-3317
Mailing Address - Country:US
Mailing Address - Phone:402-331-0701
Mailing Address - Fax:402-331-0730
Practice Address - Street 1:5305 S 96TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-3317
Practice Address - Country:US
Practice Address - Phone:402-331-0701
Practice Address - Fax:402-331-0730
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85591223G0001X
NE71151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04010443Medicaid