Healthcare Provider Details

I. General information

NPI: 1780740282
Provider Name (Legal Business Name): JOHN GERASIMOS YAKOUMATOS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19375 CONNECTICUT AVE 300
SILVER SPRING MP
20906
US

IV. Provider business mailing address

2427 SAINT ALBERT TER
BROOKEVILLE MD
20833-3258
US

V. Phone/Fax

Practice location:
  • Phone: 301-871-8002
  • Fax: 301-871-8429
Mailing address:
  • Phone: 240-938-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number09418
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: