Provider Demographics
NPI:1285193581
Name:YATES, ANDREA CHAVELEH
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CHAVELEH
Last Name:YATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10733 S OZARKS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5693
Mailing Address - Country:US
Mailing Address - Phone:281-687-8845
Mailing Address - Fax:
Practice Address - Street 1:14723 S MARKETPLACE DR STE B
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-3361
Practice Address - Country:US
Practice Address - Phone:385-340-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11680862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty