Provider Demographics
NPI:1912578626
Name:DIAZ PICHARDO, YAILIN (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:YAILIN
Middle Name:
Last Name:DIAZ PICHARDO
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ODARA DR APT 308
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-3168
Mailing Address - Country:US
Mailing Address - Phone:585-498-6968
Mailing Address - Fax:
Practice Address - Street 1:525 LEESVILLE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2328
Practice Address - Country:US
Practice Address - Phone:434-455-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014175581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics