Provider Demographics
NPI:1639214984
Name:BOAKYE-YIADOM, FOLASHADE (DDS)
Entity Type:Individual
Prefix:MS
First Name:FOLASHADE
Middle Name:
Last Name:BOAKYE-YIADOM
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 1:187-30 HILLSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3216
Mailing Address - Country:US
Mailing Address - Phone:718-264-1111
Mailing Address - Fax:718-264-9125
Practice Address - Street 1:18730 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3216
Practice Address - Country:US
Practice Address - Phone:718-264-1111
Practice Address - Fax:718-264-9125
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0462511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice