MEDICARE: YLG ENDODONTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1790599405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YLG ENDODONTICS LLC

Provider Business Mailing Address
First Line	:	6906 WILLOW ST
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-2220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 S QUINCY ST STE 325
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-2242
Country	:	US
Telephone Number	:	703-828-8188
Fax Number	:	703-828-8187

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICHOLAS EVERETT LEON-GUERRERO
Credential	:	DDS
Telephone Number	:	703-828-8188

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	01/03/2026

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