Healthcare Provider Details

I. General information

NPI: 1891197349
Provider Name (Legal Business Name): ARTHUR V YACENDA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 32 BOX 78
YUKON WV
24892-7602
US

IV. Provider business mailing address

HC 32 BOX 78
YUKON WV
24892-7602
US

V. Phone/Fax

Practice location:
  • Phone: 304-875-4612
  • Fax:
Mailing address:
  • Phone: 304-875-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2226
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: