Provider Demographics
NPI:1821726951
Name:ETAYEM, YASSMEN JAAFAR (DMD)
Entity Type:Individual
Prefix:
First Name:YASSMEN
Middle Name:JAAFAR
Last Name:ETAYEM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7623 SUSSEX CREEK DR APT 205
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4844
Mailing Address - Country:US
Mailing Address - Phone:708-739-2557
Mailing Address - Fax:
Practice Address - Street 1:15614 S HARLEM AVE STE A
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4401
Practice Address - Country:US
Practice Address - Phone:708-614-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0339061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice