Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12092 | TX |
NPI | 1083611529 |
---|---|
Provider Name | Dr. Clyde Yost |
First Address | San Antonio, TX 78211-3772 |
Second Address | San Antonio, TX 78211-3772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 09/07/2007 |