Provider Demographics
NPI:1750430724
Name:SOULES, YELENA (DDS)
Entity type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:SOULES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:SOULES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:112 ELDEN ST
Mailing Address - Street 2:SUITE S
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4874
Mailing Address - Country:US
Mailing Address - Phone:703-787-3585
Mailing Address - Fax:703-787-9887
Practice Address - Street 1:112 ELDEN ST
Practice Address - Street 2:SUITE S
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4874
Practice Address - Country:US
Practice Address - Phone:703-787-3585
Practice Address - Fax:703-787-9887
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010080861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice