Provider Demographics
NPI:1962897140
Name:YEO AND VALLARTA DENTAL DENTAL CORPORATION
Entity type:Organization
Organization Name:YEO AND VALLARTA DENTAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-238-4824
Mailing Address - Street 1:2593 S KING RD STE 9
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1880
Mailing Address - Country:US
Mailing Address - Phone:408-238-4824
Mailing Address - Fax:408-238-3028
Practice Address - Street 1:2593 S KING RD STE 9
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1880
Practice Address - Country:US
Practice Address - Phone:408-238-4824
Practice Address - Fax:408-238-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty