Provider Demographics
NPI:1508246158
Name:YEAGER, VICTORIA FUZAYLOVA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:FUZAYLOVA
Last Name:YEAGER
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 1:1604 GRAVES MILL RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5174
Mailing Address - Country:US
Mailing Address - Phone:434-385-7307
Mailing Address - Fax:434-385-0356
Practice Address - Street 1:1604 GRAVES MILL RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5174
Practice Address - Country:US
Practice Address - Phone:434-385-7307
Practice Address - Fax:434-385-0356
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist