Healthcare Provider Details

I. General information

NPI: 1831414549
Provider Name (Legal Business Name): GEORGE M. YELLICH, DDS, MS & JOSEPH A. SANDS, JR., DDS, DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 THE ALAMEDA
SAN JOSE CA
95126-2203
US

IV. Provider business mailing address

1655 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 408-288-7714
  • Fax: 408-288-7706
Mailing address:
  • Phone: 408-288-7714
  • Fax: 408-288-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number27832
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number23580
License Number StateCA

VIII. Authorized Official

Name: JIM HUFF
Title or Position: CENTER ADMINISTRATOR
Credential:
Phone: 408-556-9852