Individual
JODY LANE YEARGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
545 E JOHNSON ST, FOND DU LAC, WI 54935-2856
(920) 924-9090
Mailing address
711 JACKSON ST, OSHKOSH, WI 54901-4320
(434) 409-5010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1002693
WI
1223G0001X
General Practice Dentistry
10602
VA
Other
Enumeration date
12/19/2006
Last updated
03/15/2023
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