Provider Demographics
NPI:1487862900
Name:YAMAT, LIBRADA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIBRADA
Middle Name:C
Last Name:YAMAT
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 1:1001 SAN BRUNO AVE W
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3318
Mailing Address - Country:US
Mailing Address - Phone:650-873-4740
Mailing Address - Fax:650-873-3179
Practice Address - Street 1:1001 SAN BRUNO AVE. WEST
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066
Practice Address - Country:US
Practice Address - Phone:650-873-4740
Practice Address - Fax:650-873-3179
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist