Healthcare Provider Details

I. General information

NPI: 1437440641
Provider Name (Legal Business Name): MONICA YVETTE YAVROM D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 11TH ST S
ARLINGTON VA
22204-0827
US

IV. Provider business mailing address

2921 11TH ST S
ARLINGTON VA
22204-0827
US

V. Phone/Fax

Practice location:
  • Phone: 703-979-1425
  • Fax: 703-979-1436
Mailing address:
  • Phone: 703-979-1425
  • Fax: 703-979-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401413157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: