Provider Demographics
NPI:1720488927
Name:MOREAU, YVONELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:YVONELLE
Middle Name:
Last Name:MOREAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 COLUMBIA PIKE STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1876
Mailing Address - Country:US
Mailing Address - Phone:571-441-0041
Mailing Address - Fax:571-441-0045
Practice Address - Street 1:7023 MARTIN LUTHER KING JR HWY
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785
Practice Address - Country:US
Practice Address - Phone:301-882-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414637122300000X, 1223G0001X
DCDEN1001441122300000X
MD15700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice