Provider Demographics
NPI:1205235637
Name:YASHAR DDS A DENTAL CORPORATION
Entity type:Organization
Organization Name:YASHAR DDS A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHROKH
Authorized Official - Middle Name:
Authorized Official - Last Name:YASHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-251-1800
Mailing Address - Street 1:19223 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3367
Mailing Address - Country:US
Mailing Address - Phone:818-497-2585
Mailing Address - Fax:661-251-0860
Practice Address - Street 1:19223 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3367
Practice Address - Country:US
Practice Address - Phone:661-251-1800
Practice Address - Fax:661-251-9239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
CA50118261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental