Healthcare Provider Details

I. General information

NPI: 1215831474
Provider Name (Legal Business Name): YINA KARIME BRICENO IBRAIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14432 HULL STREET RD
CHESTERFIELD VA
23832-2525
US

IV. Provider business mailing address

906 ASHBROOK LANDING RD
MIDLOTHIAN VA
23114-7127
US

V. Phone/Fax

Practice location:
  • Phone: 804-318-3218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401419627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: