Individual
AMANDA YACOUB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11107 SUNSET HILLS RD STE 111, RESTON, VA 20190-5481
(703) 860-3200
Mailing address
11107 SUNSET HILLS RD STE 111, RESTON, VA 20190-5481
(703) 860-3200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DEN2000168
DC
1223G0001X
General Practice Dentistry
Primary
0401418068
VA
Other
Enumeration date
03/16/2021
Last updated
05/25/2023
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