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General NPI Number Information
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NPI Number | 1841659372
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Entity Type | Individual
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Provider Name | ALA YASSIN
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Gender | Female
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 4280 LAVISTA RD
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City | TUCKER
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State | GA
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Zip | 30084-5311
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Country | US
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Telephone | 786-884-8116
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Fax |
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Provider Business Mailing Address
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Address Line | 4280 LAVISTA RD
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City | TUCKER
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State | GA
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Zip | 30084-5311
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00202746
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN122214
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License Number State | GA
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