Healthcare Provider Details

I. General information

NPI: 1235918988
Provider Name (Legal Business Name): SAMANTHA YEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W HOSPITALITY LN STE 14
SAN BERNARDINO CA
92408-3329
US

IV. Provider business mailing address

164 W HOSPITALITY LN STE 14
SAN BERNARDINO CA
92408-3329
US

V. Phone/Fax

Practice location:
  • Phone: 909-888-7817
  • Fax:
Mailing address:
  • Phone: 909-888-7817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number109510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: