Provider Demographics
NPI:1952324378
Name:YAKLIGIAN, SIMON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:YAKLIGIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 VILLAGE PLAZA LOOP STE 101
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6676
Mailing Address - Country:US
Mailing Address - Phone:541-681-9999
Mailing Address - Fax:
Practice Address - Street 1:4765 VILLAGE PLAZA LOOP STE 101
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6676
Practice Address - Country:US
Practice Address - Phone:541-681-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532981223G0001X
ORD99801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice