Provider Demographics
NPI:1891197349
Name:YACENDA, ARTHUR V (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:V
Last Name:YACENDA
Suffix:
Gender:M
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:HC 32 BOX 78
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:WV
Mailing Address - Zip Code:24892-7602
Mailing Address - Country:US
Mailing Address - Phone:304-875-4612
Mailing Address - Fax:
Practice Address - Street 1:HC 32 BOX 78
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:WV
Practice Address - Zip Code:24892-7602
Practice Address - Country:US
Practice Address - Phone:304-875-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV013503100Medicaid