Provider Demographics
NPI:1083887194
Name:BORARATH YANN, D.D.S., PC
Entity Type:Organization
Organization Name:BORARATH YANN, D.D.S., PC
Other - Org Name:WELLINGTON DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORARATH
Authorized Official - Middle Name:M
Authorized Official - Last Name:YANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-330-0430
Mailing Address - Street 1:10068 DUMFRIES RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-7949
Mailing Address - Country:US
Mailing Address - Phone:703-330-0430
Mailing Address - Fax:703-330-0464
Practice Address - Street 1:10068 DUMFRIES RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-7949
Practice Address - Country:US
Practice Address - Phone:703-330-0430
Practice Address - Fax:703-330-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty