Healthcare Provider Details

I. General information

NPI: 1225370216
Provider Name (Legal Business Name): YONESHA VAL PHAIR D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 COURT STREET
JEFFERSON NC
28640
US

IV. Provider business mailing address

PO BOX 208
JEFFERSON NC
28640-0208
US

V. Phone/Fax

Practice location:
  • Phone: 336-246-9449
  • Fax: 336-846-1910
Mailing address:
  • Phone: 336-246-9449
  • Fax: 336-982-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10980
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10980
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number057537
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: