Provider Demographics
NPI:1194017541
Name:YABAR AND RIVAS DENTAL CORPORATION
Entity Type:Organization
Organization Name:YABAR AND RIVAS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILMER
Authorized Official - Middle Name:
Authorized Official - Last Name:YABAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-855-9212
Mailing Address - Street 1:23823 EL TORO RD
Mailing Address - Street 2:SUITE E122
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4743
Mailing Address - Country:US
Mailing Address - Phone:949-855-9212
Mailing Address - Fax:949-855-9272
Practice Address - Street 1:23823 EL TORO RD
Practice Address - Street 2:SUITE E122
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4743
Practice Address - Country:US
Practice Address - Phone:949-855-9212
Practice Address - Fax:949-855-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92050OtherDENTI-CAL