Provider Demographics
NPI:1861245300
Name:YOONAN, BERTA (DDS)
Entity type:Individual
Prefix:DR
First Name:BERTA
Middle Name:
Last Name:YOONAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BERTA
Other - Middle Name:
Other - Last Name:TARVERDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11040 BOLLINGER CANYON RD STE I
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3723 HONEYCREEPER DR
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-8551
Practice Address - Country:US
Practice Address - Phone:209-417-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1084421223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics