Provider Demographics
NPI:1063784239
Name:YASHARI, SIMON (DDS,MBA, ORTHO)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:YASHARI
Suffix:
Gender:M
Credentials:DDS,MBA, ORTHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 KROLL WAY
Mailing Address - Street 2:#246
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1167
Mailing Address - Country:US
Mailing Address - Phone:310-770-8121
Mailing Address - Fax:
Practice Address - Street 1:1101 N NORMA ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3157
Practice Address - Country:US
Practice Address - Phone:760-446-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV61981223G0001X
CA644131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice