Provider Demographics
NPI:1225146624
Name:YULIA NEGOM DDS INC
Entity Type:Organization
Organization Name:YULIA NEGOM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:YULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-951-0309
Mailing Address - Street 1:44725 10TH ST W
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3033
Mailing Address - Country:US
Mailing Address - Phone:661-951-0309
Mailing Address - Fax:661-951-9847
Practice Address - Street 1:44725 10TH ST W
Practice Address - Street 2:SUITE 160
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3033
Practice Address - Country:US
Practice Address - Phone:661-951-0309
Practice Address - Fax:661-951-9847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty