Provider Demographics
NPI:1255478897
Name:YEHEZKEL, SHAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAUL
Middle Name:
Last Name:YEHEZKEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RED ROCK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3067
Mailing Address - Country:US
Mailing Address - Phone:949-857-4640
Mailing Address - Fax:949-559-7909
Practice Address - Street 1:4902 IRVINE CENTER DR
Practice Address - Street 2:SUITE 111
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3305
Practice Address - Country:US
Practice Address - Phone:949-559-0674
Practice Address - Fax:949-559-7909
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry