Provider Demographics
NPI:1467645291
Name:YUCAIPA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:YUCAIPA FAMILY DENTISTRY
Other - Org Name:YUCAIPA FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIOT
Authorized Official - Middle Name:M
Authorized Official - Last Name:YEO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-797-0303
Mailing Address - Street 1:34488 YUCAIPA BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399
Mailing Address - Country:US
Mailing Address - Phone:909-797-0303
Mailing Address - Fax:909-797-8714
Practice Address - Street 1:34848 YUCAIPA BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399
Practice Address - Country:US
Practice Address - Phone:909-797-0303
Practice Address - Fax:909-797-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty