Provider Demographics
NPI:1760472690
Name:CLARK, YOLANDA CHERYL (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:CHERYL
Last Name:CLARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:YOLANDA
Other - Middle Name:CHERYL
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1385 FORDHAM DRIVE
Mailing Address - Street 2:STE 106
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464
Mailing Address - Country:US
Mailing Address - Phone:757-451-7003
Mailing Address - Fax:757-420-7177
Practice Address - Street 1:4239 HOLLAND RD
Practice Address - Street 2:SUITE 762-A
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1941
Practice Address - Country:US
Practice Address - Phone:757-467-3618
Practice Address - Fax:757-467-1455
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04011027071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice