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General NPI Number Information
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NPI Number | 1740460187
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Entity Type | Organization
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Legal Business Name | YACOUB A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 1008 E WASHINGTON AVE
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City | EL CAJON
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State | CA
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Zip | 92020
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Country | US
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Telephone | 619-334-1468
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Fax | 619-328-4035
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Provider Business Mailing Address
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Address Line | 1008 E WASHINGTON AVE
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City | EL CAJON
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State | CA
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Zip | 92020-6614
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Country | US
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Telephone | 619-334-1468
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Fax | 619-328-4035
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Authorized Official
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Title or Position | OWNER
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Name | KHALID MARQUS YACOUB
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Credential | DDS
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Telephone | 619-334-1468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43510
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License Number State | CA
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