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General NPI Number Information
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NPI Number | 1407487622
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Entity Type | Organization
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Legal Business Name | LENISE N. YARBER D.D.S , PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 5035 W SLAUSON AVE STE G
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City | LOS ANGELES
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State | CA
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Zip | 90056-1647
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Country | US
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Telephone | 323-296-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 5035 W SLAUSON AVE STE G
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City | LOS ANGELES
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State | CA
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Zip | 90056-1647
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/DENTIST
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Name | DR. LENISE N YARBER
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Credential | DDS
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Telephone | 310-327-7969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics 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 | 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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