Healthcare Provider Details

I. General information

NPI: 1578699088
Provider Name (Legal Business Name): YVETTE WEIR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YVETTE WEIR GLADSTONE

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON STREET 1204
SILVER SPRING MD
20910
US

IV. Provider business mailing address

8630 FENTON STREET 1204
SILVER SPRING MD
20910
US

V. Phone/Fax

Practice location:
  • Phone: 240-839-5811
  • Fax: 301-495-0318
Mailing address:
  • Phone: 240-839-5811
  • Fax: 301-495-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11178
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16975
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: