Provider Demographics
NPI:1265579247
Name:M YAGHI DDS PA
Entity type:Organization
Organization Name:M YAGHI DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:YAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-547-8783
Mailing Address - Street 1:8220 UNIVERSITY EXECUTIVE PARK DRIVE
Mailing Address - Street 2:110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-547-8783
Mailing Address - Fax:704-510-2530
Practice Address - Street 1:8220 UNIVERSITY EXECUTIVE PARK DRIVE
Practice Address - Street 2:110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-547-8783
Practice Address - Fax:704-510-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
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
NC89013Y4Medicaid