Provider Demographics
NPI:1659664084
Name:M YAGHI DDS & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:M YAGHI DDS & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-277-9540
Mailing Address - Street 1:1212 SPRUCE ST
Mailing Address - Street 2:STE 201
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3385
Mailing Address - Country:US
Mailing Address - Phone:704-825-3455
Mailing Address - Fax:704-825-3480
Practice Address - Street 1:1212 SPRUCE ST
Practice Address - Street 2:STE 201
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3385
Practice Address - Country:US
Practice Address - Phone:704-825-3455
Practice Address - Fax:704-825-3480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901375Medicaid