Provider Demographics
NPI:1326145285
Name:YERONDOPOULOS, TODD MATTHEW
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MATTHEW
Last Name:YERONDOPOULOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 1ST ST
Mailing Address - Street 2:SUITE 155
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7361
Mailing Address - Country:US
Mailing Address - Phone:925-931-9100
Mailing Address - Fax:408-730-8662
Practice Address - Street 1:4713 1ST ST
Practice Address - Street 2:SUITE 155
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7361
Practice Address - Country:US
Practice Address - Phone:925-931-9100
Practice Address - Fax:408-730-8662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist