Healthcare Provider Details

I. General information

NPI: 1205499183
Provider Name (Legal Business Name): YEATON AND MAR DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 W CHANNEL ISLANDS BLVD
OXNARD CA
93033-4203
US

IV. Provider business mailing address

PO BOX 920050
DALLAS TX
75392-0050
US

V. Phone/Fax

Practice location:
  • Phone: 805-253-1796
  • Fax: 805-253-1871
Mailing address:
  • Phone: 714-845-8890
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MARIA H YEATON
Title or Position: OWNER
Credential: DDS
Phone: 805-253-1796