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General NPI Number Information
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NPI Number | 1205370087
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Entity Type | Organization
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Legal Business Name | YASSIM GOMES DENTAL CORPORATION
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 2690 PACIFIC AVE SUITE 255
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City | LONG BEACH
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State | CA
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Zip | 90806-2657
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Country | US
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Telephone | 562-330-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 2690 PACIFIC AVE SUITE 255
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City | LONG BEACH
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State | CA
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Zip | 90806
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Country | US
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Telephone | 562-330-0557
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRAMAIA YASSIM
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Credential | D.D.S.
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Telephone | 562-330-0557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61093
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License Number State | CA
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