Healthcare Provider Details

I. General information

NPI: 1710431747
Provider Name (Legal Business Name): MARIA HADI YEATON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10445 LAUREL CANYON BLVD
PACOIMA CA
91331-3605
US

IV. Provider business mailing address

1997 MARCO DR
CAMARILLO CA
93010-2433
US

V. Phone/Fax

Practice location:
  • Phone: 818-890-8070
  • Fax:
Mailing address:
  • Phone: 714-757-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: