Provider Demographics
NPI:1669533089
Name:YATES, BRANDI R (DMD)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:R
Last Name:YATES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N PLAZA DR
Mailing Address - Street 2:STE 230
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2511
Mailing Address - Country:US
Mailing Address - Phone:859-881-9398
Mailing Address - Fax:859-881-3689
Practice Address - Street 1:750 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1444
Practice Address - Country:US
Practice Address - Phone:606-783-0182
Practice Address - Fax:606-783-0272
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100105050Medicaid