Provider Demographics
NPI:1538243969
Name:YAKULIS, CHARLES W (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:YAKULIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690
Mailing Address - Country:US
Mailing Address - Phone:724-568-3345
Mailing Address - Fax:724-567-2755
Practice Address - Street 1:181 WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:VANDERGRIFT
Practice Address - State:PA
Practice Address - Zip Code:15690
Practice Address - Country:US
Practice Address - Phone:724-568-3345
Practice Address - Fax:724-567-2755
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019097L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist