Provider Demographics
NPI:1548384845
Name:ROBERT S. YONEDA DDS INC.
Entity Type:Organization
Organization Name:ROBERT S. YONEDA DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:YONEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-251-3766
Mailing Address - Street 1:155 N JACKSON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1925
Mailing Address - Country:US
Mailing Address - Phone:408-251-3766
Mailing Address - Fax:408-251-9168
Practice Address - Street 1:155 N JACKSON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1925
Practice Address - Country:US
Practice Address - Phone:408-251-3766
Practice Address - Fax:408-251-9168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB25046-01Medicaid