Individual
MINA YACOUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1646 W CHESTER PIKE STE 1, WEST CHESTER, PA 19382-7979
(610) 590-4568
Mailing address
1646 W CHESTER PIKE STE 1, WEST CHESTER, PA 19382-7979
(610) 590-4568
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS042848
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2020
Last updated
09/19/2021
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