Provider Demographics
NPI:1720105661
Name:VANN, YAKEIKA LYNETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:YAKEIKA
Middle Name:LYNETTE
Last Name:VANN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 WYALONG DR
Mailing Address - Street 2:STE. C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7847
Mailing Address - Country:US
Mailing Address - Phone:601-630-5188
Mailing Address - Fax:
Practice Address - Street 1:5716 WYALONG DR
Practice Address - Street 2:STE. C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7847
Practice Address - Country:US
Practice Address - Phone:601-630-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3400-061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02629792Medicaid
NC5908012Medicaid