Provider Demographics
NPI:1205370087
Name:YASSIM GOMES DENTAL CORPORATION
Entity type:Organization
Organization Name:YASSIM GOMES DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRAMAIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YASSIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-330-0557
Mailing Address - Street 1:2690 PACIFIC AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-330-0557
Mailing Address - Fax:
Practice Address - Street 1:2690 PACIFIC AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2657
Practice Address - Country:US
Practice Address - Phone:562-330-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty