MEDICARE: SIDERMAN, YAMPOLSKY DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry
2	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396949541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIDERMAN, YAMPOLSKY DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	6601 RUGBY AVE
Second Line	:	#400
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4040
Country	:	US
Telephone Number	:	323-585-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 RUGBY AVE
Second Line	:	#400
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4040
Country	:	US
Telephone Number	:	323-585-1515
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERRY SIDERMAN
Credential	:	DDS
Telephone Number	:	323-585-1515

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/10/2007

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Directions to “SIDERMAN, YAMPOLSKY DENTAL CORPORATION ” Practice Location

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