Provider Demographics
NPI:1013038421
Name:YUMIACO, AGNES SICAT (DMD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:SICAT
Last Name:YUMIACO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SCRIPPS DR STE 305
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6207
Mailing Address - Country:US
Mailing Address - Phone:916-929-0248
Mailing Address - Fax:916-929-0244
Practice Address - Street 1:2 SCRIPPS DR STE 305
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6207
Practice Address - Country:US
Practice Address - Phone:916-929-0248
Practice Address - Fax:916-929-0244
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice