Provider Demographics
NPI:1295947257
Name:YAQUI, LUIS EDUARDO (DDS)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:EDUARDO
Last Name:YAQUI
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 1:6164 GREEN MEADOW PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3313
Mailing Address - Country:US
Mailing Address - Phone:410-409-6332
Mailing Address - Fax:
Practice Address - Street 1:7806 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-2231
Practice Address - Country:US
Practice Address - Phone:703-368-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014116971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice