Provider Demographics
NPI:1295289635
Name:YANCHICK, SANDY (RDH, PHDHP, BS)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:YANCHICK
Suffix:
Gender:F
Credentials:RDH, PHDHP, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 SR 29 S
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18636-7854
Mailing Address - Country:US
Mailing Address - Phone:570-298-2161
Mailing Address - Fax:
Practice Address - Street 1:2888 SR 29 S
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:PA
Practice Address - Zip Code:18636-7854
Practice Address - Country:US
Practice Address - Phone:570-298-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-13
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH012134124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist