Healthcare Provider Details

I. General information

NPI: 1144144841
Provider Name (Legal Business Name): PETER YACOUB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 CROWN AVE
LANCASTER PA
17601-6322
US

IV. Provider business mailing address

49 LINDEN AVE
BELLEVILLE NJ
07109-2719
US

V. Phone/Fax

Practice location:
  • Phone: 717-481-7645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS046036
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: