Provider Demographics
NPI:1679803852
Name:YACOUB INC
Entity type:Organization
Organization Name:YACOUB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YACOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-266-1101
Mailing Address - Street 1:2123 N 1ST AVE
Mailing Address - Street 2:SUITE A2
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-3956
Mailing Address - Country:US
Mailing Address - Phone:610-266-1101
Mailing Address - Fax:610-266-1170
Practice Address - Street 1:2123 N 1ST AVE
Practice Address - Street 2:SUITE A2
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3956
Practice Address - Country:US
Practice Address - Phone:610-266-1101
Practice Address - Fax:610-266-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0372661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1891984258Medicaid