Provider Demographics
NPI:1053529354
Name:YANEZA, MERLE L (DDS)
Entity type:Individual
Prefix:
First Name:MERLE
Middle Name:L
Last Name:YANEZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9146 SEPULVEDA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-6948
Mailing Address - Country:US
Mailing Address - Phone:818-830-7000
Mailing Address - Fax:818-830-7013
Practice Address - Street 1:9146 SEPULVEDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-6948
Practice Address - Country:US
Practice Address - Phone:818-830-7000
Practice Address - Fax:818-830-7013
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD27219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD27219OtherDENTI-CAL