Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901600142 | MI |
NPI | 1003476565 |
---|---|
Provider Name | Dr. Adam Yazback |
First Address | Dearborn, MI 48126-4112 |
Second Address | Dearborn Heights, MI 48127-2597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 23/07/2019 |