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General NPI Number Information
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NPI Number | 1649521360
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Entity Type | Organization
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Legal Business Name | LAUREL ENDODONTICS
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 1178 BRITTAN AVE
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City | SAN CARLOS
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State | CA
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Zip | 94070-3929
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Country | US
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Telephone | 650-654-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 1178 BRITTAN AVE
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City | SAN CARLOS
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State | CA
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Zip | 94070-3929
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Country | US
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Telephone | 650-654-3636
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEAN YANG
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Credential | D.M.D.
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Telephone | 650-654-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | CA 56681
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License Number State | CA
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