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General NPI Number Information
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NPI Number | 1396949541
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Entity Type | Organization
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Legal Business Name | SIDERMAN, YAMPOLSKY DENTAL CORPORATION
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 6601 RUGBY AVE #400
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4040
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Country | US
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Telephone | 323-585-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 6601 RUGBY AVE #400
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4040
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Country | US
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Telephone | 323-585-1515
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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. JERRY SIDERMAN
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Credential | DDS
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Telephone | 323-585-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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