Healthcare Provider Details

I. General information

NPI: 1790599405
Provider Name (Legal Business Name): YLG ENDODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 S QUINCY ST STE 325
ARLINGTON VA
22206-2242
US

IV. Provider business mailing address

6906 WILLOW ST
FALLS CHURCH VA
22046-2220
US

V. Phone/Fax

Practice location:
  • Phone: 703-828-8188
  • Fax: 703-828-8187
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS EVERETT LEON-GUERRERO
Title or Position: OWNER
Credential: DDS
Phone: 703-828-8188