Provider Demographics
NPI:1396969507
Name:YEOSHOUA, ODED (DMD)
Entity type:Individual
Prefix:DR
First Name:ODED
Middle Name:
Last Name:YEOSHOUA
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 1:3911 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6795
Mailing Address - Country:US
Mailing Address - Phone:954-987-3344
Mailing Address - Fax:954-987-7224
Practice Address - Street 1:3911 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6795
Practice Address - Country:US
Practice Address - Phone:954-987-3344
Practice Address - Fax:954-987-7224
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice