Provider Demographics
NPI:1811549272
Name:YACOUB, CAROL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:YACOUB
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 1:16334 HUNTER PL
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-7829
Mailing Address - Country:US
Mailing Address - Phone:614-288-3979
Mailing Address - Fax:
Practice Address - Street 1:1614 VILLAGE MARKET BLVD SE STE 100
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-5113
Practice Address - Country:US
Practice Address - Phone:703-777-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014168471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice