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General NPI Number Information
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NPI Number | 1912578626
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Entity Type | Individual
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Provider Name | YAILIN DIAZ PICHARDO DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 07/03/2021
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Last Update Date | 07/03/2021
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Provider Practice Location Address
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Address Line | 525 LEESVILLE RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-2328
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Country | US
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Telephone | 434-455-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 22 ODARA DR APT 308
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City | FOREST
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State | VA
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Zip | 24551-3168
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Country | US
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Telephone | 585-498-6968
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0401417558
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License Number State | VA
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