Healthcare Provider Details

I. General information

NPI: 1346626835
Provider Name (Legal Business Name): JENIN YAHYA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

12743 FAIR BRIAR LN
FAIRFAX VA
22033-3850
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7952
  • Fax:
Mailing address:
  • Phone: 703-625-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401415015
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021701
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: