Provider Demographics
NPI:1043401664
Name:LA SIERRA FAMILY DENTISTRY
Entity type:Organization
Organization Name:LA SIERRA FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIOT
Authorized Official - Middle Name:M
Authorized Official - Last Name:YEO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-354-9550
Mailing Address - Street 1:3410 LA SIERRA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-354-9550
Mailing Address - Fax:951-354-8644
Practice Address - Street 1:3410 LA SIERRA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-354-9550
Practice Address - Fax:951-354-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty