Douglas Michael Yarris, D.D.S.
Individual provider Active NPI General Practice Dentistry · Crockett, CA
NPI 1063667590 · NPPES record last updated Nov 25, 2008
Key facts
- NPI
- 1063667590
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 031887 (CA)
- Practice address
- 716 2ND Ave
Crockett, CA 94525-1111 - Phone
- (510) 787-1471
- Fax
- (510) 787-3018
- NPI assigned
- Nov 25, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031887 | CA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 031887 | CA | Yes |
Addresses
Primary practice location
716 2ND Ave
Crockett, CA 94525-1111
Mailing address
716 2ND Ave
Crockett, CA 94525-1111
Phone (510) 787-1471
Other providers in Crockett, CA
- Mohammad Hadi Soltani
- Karen Louise Valiton
- Shelby Verducci
- Christopher Walk
- Rosa Tupina Yaotonalcuauhtli-Orta
All providers in Crockett, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.