Provider Demographics
NPI:1720166622
Name:MANN, YOLANDA OCTAVIA
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:OCTAVIA
Last Name:MANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 CASABLANCA RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2225
Mailing Address - Country:US
Mailing Address - Phone:757-961-1215
Mailing Address - Fax:
Practice Address - Street 1:USS GEORGE WASHINGTON CVN-73 BOX 66
Practice Address - Street 2:FPO AE 09550
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23501-0066
Practice Address - Country:US
Practice Address - Phone:757-396-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist