Healthcare Provider Details

I. General information

NPI: 1093604498
Provider Name (Legal Business Name): YASHITA SETHIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12113 MANOR GLEN LN
GLEN ALLEN VA
23059-7158
US

IV. Provider business mailing address

12113 MANOR GLEN LN
GLEN ALLEN VA
23059-7158
US

V. Phone/Fax

Practice location:
  • Phone: 757-258-1042
  • Fax: 757-258-1042
Mailing address:
  • Phone: 757-258-1042
  • Fax: 757-258-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420197
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: