Healthcare Provider Details

I. General information

NPI: 1720742802
Provider Name (Legal Business Name): MONIQUE NATASHA YEARWOOD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE BLDG DENTAL
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

2516 BEDFORD AVE APT 3D
BROOKLYN NY
11226-7044
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-2299
  • Fax:
Mailing address:
  • Phone: 917-406-8562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number031243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: