Provider Demographics
NPI:1992233266
Name:RODENAS, YANN JULIEN (DMD)
Entity type:Individual
Prefix:DR
First Name:YANN
Middle Name:JULIEN
Last Name:RODENAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 1ST INFANTRY DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5210
Mailing Address - Country:US
Mailing Address - Phone:765-702-1557
Mailing Address - Fax:
Practice Address - Street 1:968 1ST INFANTRY DIVISION RD
Practice Address - Street 2:
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5210
Practice Address - Country:US
Practice Address - Phone:765-702-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC90281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019031132OtherSTATE LICENSE