Provider Demographics
NPI:1871983759
Name:YOST, DENNIS (CAC III)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:YOST
Suffix:
Gender:M
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 LONGVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6246
Mailing Address - Country:US
Mailing Address - Phone:303-579-2845
Mailing Address - Fax:
Practice Address - Street 1:3368 LONGVIEW BLVD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-6246
Practice Address - Country:US
Practice Address - Phone:303-579-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6107171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator