Provider Demographics
NPI:1437121936
Name:YSIDRO, CAROL M (DDS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:YSIDRO
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:PO BOX 356
Mailing Address - Street 2:1401 W. GRAND
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-0356
Mailing Address - Country:US
Mailing Address - Phone:316-524-8661
Mailing Address - Fax:316-524-0331
Practice Address - Street 1:1401 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-1261
Practice Address - Country:US
Practice Address - Phone:316-524-8661
Practice Address - Fax:316-524-0331
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS600241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice