Provider Demographics
NPI:1730598673
Name:YAMPOSLKY, GERSHFELD DENTAL CORPORATION
Entity type:Organization
Organization Name:YAMPOSLKY, GERSHFELD DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMPOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-523-9009
Mailing Address - Street 1:800 SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3374
Mailing Address - Country:US
Mailing Address - Phone:818-898-1818
Mailing Address - Fax:
Practice Address - Street 1:800 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3374
Practice Address - Country:US
Practice Address - Phone:818-898-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA618461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty