Provider Demographics
NPI:1871661751
Name:YOZA, ETHAN JERRY (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:JERRY
Last Name:YOZA
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 W UNION HILLS DR STE 430
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8108
Mailing Address - Country:US
Mailing Address - Phone:623-398-7334
Mailing Address - Fax:623-977-4838
Practice Address - Street 1:8110 W UNION HILLS DR STE 430
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8108
Practice Address - Country:US
Practice Address - Phone:623-398-7334
Practice Address - Fax:623-977-4838
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist