Provider Demographics
NPI:1346251535
Name:GAMEZ, YADIRA L (DDS)
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:L
Last Name:GAMEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 DAIRY MART RD
Mailing Address - Street 2:STE 120
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173
Mailing Address - Country:US
Mailing Address - Phone:619-428-2436
Mailing Address - Fax:619-428-2447
Practice Address - Street 1:2004 DAIRY MART RD
Practice Address - Street 2:STE 120
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173
Practice Address - Country:US
Practice Address - Phone:619-428-2436
Practice Address - Fax:619-428-2447
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist