Provider Demographics
NPI:1194546838
Name:YABAR TELLO, MIRTHA JOHANNA I (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRTHA
Middle Name:JOHANNA
Last Name:YABAR TELLO
Suffix:I
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18465 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-8868
Mailing Address - Country:US
Mailing Address - Phone:951-201-1792
Mailing Address - Fax:
Practice Address - Street 1:121 BARBOZA ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-1901
Practice Address - Country:US
Practice Address - Phone:800-492-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist