Provider Demographics
NPI:1437211349
Name:SADEK, YASSER (DDS)
Entity Type:Individual
Prefix:
First Name:YASSER
Middle Name:
Last Name:SADEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 W OLIVE AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2433
Mailing Address - Country:US
Mailing Address - Phone:209-383-6133
Mailing Address - Fax:209-383-6421
Practice Address - Street 1:645 W OLIVE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2433
Practice Address - Country:US
Practice Address - Phone:209-383-6133
Practice Address - Fax:209-383-6421
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9182901Medicaid