| Provider / Organization | NPI | Date Certified |
|---|---|---|
| AMANDA YACOUB | 1336724897 | 2021-03-16 |
Amanda Yacoub is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1336724897. Registration indicates Amanda Yacoub is a provider of access to dentists-general services with a specialization in Dental Providers, Dentist (Dental Providers, Dentist) (Dentist, ) (Dental, ) (Dentist, Dental Providers) Access to Dentists-General (Dental Providers, Dentist) (Dental Providers, Dentist) (Dentist: General Practice, ) (Dental, ) (Dentist General Practice, Dental Providers) (Dentist, )
| Entity Type | Individual |
| Provider Name | Amanda Yacoub |
| Practice Office Address | 11107 SUNSET HILLS RD STE 111 RESTON, VA US |
| Practice Office Telephone | 7038603200 |
| Mailing Address | 11107 SUNSET HILLS RD STE 111 RESTON, VA 201905481 US |
| Business Telephone | 7038603200 |
| Code | Practice | License No State |
|---|---|---|
| 122300000X | Access to Dentists-General Dental Providers Dentist Dental Providers Dentist Dentist Dental Dentist Dental Providers | DEN2000168
DC |
| 1223G0001X PRIMARY | Access to Dentists-General Dental Providers Dentist Dental Providers Dentist Dentist: General Practice Dental Dentist General Practice Dental Providers Dentist | 0401418068
VA |