# INNOVATION DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295325991
- **Authorized official:** BORARATH M YANN D.D.S. (OWNER/PRESIDENT)
- **Authorized official phone:** (703) 330-3933

## Contact information

- **Practice address:** 9070 DEVLIN RD, STE 110, BRISTOW, VA 20136
- **Practice address phone:** (703) 330-3933
- **Practice address fax:** (571) 248-2043
- **Mailing address:** 9070 DEVLIN RD, STE 110, BRISTOW, VA 20136
- **Mailing address phone:** (703) 330-3933
- **Mailing address fax:** (571) 248-2043

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 01/26/2021
- **Last updated:** 01/26/2021