Provider Demographics
NPI:1821411968
Name:LENISE N. YARBER D.D.S , PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:LENISE N. YARBER D.D.S , PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:YARBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-327-7969
Mailing Address - Street 1:20930 BONITA ST
Mailing Address - Street 2:SUITE Y
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3680
Mailing Address - Country:US
Mailing Address - Phone:310-327-7969
Mailing Address - Fax:
Practice Address - Street 1:20930 BONITA ST
Practice Address - Street 2:SUITE Y
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3680
Practice Address - Country:US
Practice Address - Phone:310-327-7969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-25
Last Update Date:2014-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA613931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty