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Organization
SIDERMAN, YAMPOLSKY DENTAL CORPORATION
Active
Organization
SIDERMAN, YAMPOLSKY DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY SIDERMAN DDS (PRESIDENT)
(323) 585-1515
Entity
Organization
Contact information
Practice address
6601 RUGBY AVE, #400, HUNTINGTON PARK, CA 90255-4040
(323) 585-1515
Mailing address
6601 RUGBY AVE, #400, HUNTINGTON PARK, CA 90255-4040
(323) 585-1515
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G91803
—
CA
Enumeration date
06/12/2007
Last updated
08/10/2007
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