Provider Demographics
NPI:1427661594
Name:YACKLEY, XANDRIA KHRYSTYNNE (DDS, BS)
Entity type:Individual
Prefix:DR
First Name:XANDRIA
Middle Name:KHRYSTYNNE
Last Name:YACKLEY
Suffix:
Gender:F
Credentials:DDS, BS
Other - Prefix:DR
Other - First Name:XANDRIA
Other - Middle Name:KHRYSTYNNE
Other - Last Name:PERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, BS
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:SELBY
Mailing Address - State:SD
Mailing Address - Zip Code:57472-0057
Mailing Address - Country:US
Mailing Address - Phone:605-848-1372
Mailing Address - Fax:
Practice Address - Street 1:611 2ND AVE EAST
Practice Address - Street 2:
Practice Address - City:MCLAUGHLIN
Practice Address - State:SD
Practice Address - Zip Code:57642
Practice Address - Country:US
Practice Address - Phone:605-823-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE76611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice