1497169718 NPI number — MRS. MARILYN SAMPEDRO YABER D.D.S.

Table of content: MRS. MARILYN SAMPEDRO YABER D.D.S. (NPI 1497169718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497169718 NPI number — MRS. MARILYN SAMPEDRO YABER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YABER
Provider First Name:
MARILYN
Provider Middle Name:
SAMPEDRO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAMPEDRO
Provider Other First Name:
MARILYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.D.H.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497169718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 GYPSY LN
Provider Second Line Business Mailing Address:
3RD FLOOR, DENTAL CLINIC
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44504-1315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-884-3058
Provider Business Mailing Address Fax Number:
330-884-5788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 GYPSY LN
Provider Second Line Business Practice Location Address:
3RD FLOOR, DENTAL CLINIC
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44504-1315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-884-3058
Provider Business Practice Location Address Fax Number:
330-884-5788
Provider Enumeration Date:
06/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  RES.3454 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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