Provider Demographics
NPI:1851635106
Name:YERRO, MANUEL FRANKLIN DADIVAS (DMD)
Entity type:Individual
Prefix:DR
First Name:MANUEL FRANKLIN
Middle Name:DADIVAS
Last Name:YERRO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 VAN NUYS BLVD.
Mailing Address - Street 2:STE. D
Mailing Address - City:PANORAMA
Mailing Address - State:CA
Mailing Address - Zip Code:91402
Mailing Address - Country:US
Mailing Address - Phone:818-830-2392
Mailing Address - Fax:818-830-2391
Practice Address - Street 1:8780 VAN NUYS BLVD.
Practice Address - Street 2:STE. D
Practice Address - City:PANORAMA
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:818-830-2392
Practice Address - Fax:818-830-2391
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice