Provider Demographics
NPI:1720742802
Name:YEARWOOD, MONIQUE NATASHA (RDH)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:NATASHA
Last Name:YEARWOOD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 BEDFORD AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7044
Mailing Address - Country:US
Mailing Address - Phone:917-406-8562
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVE BLDG DENTAL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-245-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031243124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist