Provider Demographics
NPI:1487788139
Name:YAROS, KENNETH ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALAN
Last Name:YAROS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CERRO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1714
Mailing Address - Country:US
Mailing Address - Phone:858-792-0669
Mailing Address - Fax:858-792-8326
Practice Address - Street 1:2180 GARNET AVE
Practice Address - Street 2:SUITE 1-K
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3610
Practice Address - Country:US
Practice Address - Phone:858-270-4904
Practice Address - Fax:858-270-4275
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice