Provider Demographics
NPI:1861916504
Name:DE MESA, YVONNE ARLENE
Entity type:Individual
Prefix:
First Name:YVONNE ARLENE
Middle Name:
Last Name:DE MESA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 WILLOW RD STE A
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8576
Mailing Address - Country:US
Mailing Address - Phone:925-462-2311
Mailing Address - Fax:925-462-2313
Practice Address - Street 1:4430 WILLOW RD STE A
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8576
Practice Address - Country:US
Practice Address - Phone:925-462-2311
Practice Address - Fax:925-462-2313
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS388301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice