Individual
ALA YASSIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4280 LAVISTA RD, TUCKER, GA 30084-5311
(786) 884-8116
Mailing address
4280 LAVISTA RD, TUCKER, GA 30084-5311
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DEN.00202746
CO
1223P0300X
Periodontics
Primary
DN122214
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
66286026
—
CO
Enumeration date
02/11/2016
Last updated
01/07/2021
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