Provider Demographics
NPI:1881869337
Name:GEORGE M. YELLICH, DDS, MS., INC. AND CHENG, DDS, MD, INC, PARTNERSHIP
Entity type:Organization
Organization Name:GEORGE M. YELLICH, DDS, MS., INC. AND CHENG, DDS, MD, INC, PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYESE
Authorized Official - Middle Name:K
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-475-0221
Mailing Address - Street 1:1663 DOMINICAN WAY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1527
Mailing Address - Country:US
Mailing Address - Phone:831-475-0221
Mailing Address - Fax:831-475-3573
Practice Address - Street 1:1663 DOMINICAN WAY
Practice Address - Street 2:SUITE 112
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1527
Practice Address - Country:US
Practice Address - Phone:831-475-0221
Practice Address - Fax:831-475-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty