Provider Demographics
NPI:1902951122
Name:YASKUS, BARRY ERVIN (DDS)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:ERVIN
Last Name:YASKUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BARBARA ST.
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870
Mailing Address - Country:US
Mailing Address - Phone:406-777-5582
Mailing Address - Fax:406-558-4794
Practice Address - Street 1:201 BARBARA ST.
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870
Practice Address - Country:US
Practice Address - Phone:406-777-5582
Practice Address - Fax:406-558-4794
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT013184OtherBLUE CROSS BLUE SHILED
MT5512546OtherCHIP
MT1313335OtherUNITED CONCORDIA
MT0113126Medicaid