Provider Demographics
NPI:1396399937
Name:YONAN, ELIEZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIEZA
Middle Name:
Last Name:YONAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ELIEZA
Other - Middle Name:
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6222 E BLANCHE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:480-516-7851
Mailing Address - Fax:
Practice Address - Street 1:19420 N 59TH AVE STE D400
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-2829
Practice Address - Country:US
Practice Address - Phone:602-978-9794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist