Individual
JOHN MEENA YACOUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
30-18 208TH ST, BAYSIDE, NY 14120
(718) 909-9049
Mailing address
3018 208TH ST, BAYSIDE, NY 11360-2423
(718) 909-9049
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
058271
NY
Other
Enumeration date
02/05/2014
Last updated
11/05/2018
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