Provider Demographics
NPI:1346374840
Name:KAPILA, YVONNE L (DDS)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:L
Last Name:KAPILA
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 1:10833 LE CONTE AVE BOX 951668, MAIL 53-039
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1668
Mailing Address - Country:US
Mailing Address - Phone:310-825-5543
Mailing Address - Fax:310-206-3282
Practice Address - Street 1:10833 LE CONTE AVE RM 53-039
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3308
Practice Address - Country:US
Practice Address - Phone:310-825-5543
Practice Address - Fax:310-206-3282
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018813122300000X, 1223G0001X
CA38425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID188130OtherBCBS OF MI DENTAL