Healthcare Provider Details

I. General information

NPI: 1407487622
Provider Name (Legal Business Name): LENISE N. YARBER D.D.S , PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 W SLAUSON AVE STE G
LOS ANGELES CA
90056-1647
US

IV. Provider business mailing address

5035 W SLAUSON AVE STE G
LOS ANGELES CA
90056-1647
US

V. Phone/Fax

Practice location:
  • Phone: 323-296-0211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LENISE N YARBER
Title or Position: CEO/DENTIST
Credential: DDS
Phone: 310-327-7969