Provider Demographics
NPI:1881461838
Name:YVDA PA LLC
Entity type:Organization
Organization Name:YVDA PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-570-0764
Mailing Address - Street 1:28 LONG SANDS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1166
Mailing Address - Country:US
Mailing Address - Phone:207-363-6551
Mailing Address - Fax:207-363-1335
Practice Address - Street 1:28 LONG SANDS RD STE 2
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1166
Practice Address - Country:US
Practice Address - Phone:207-363-6551
Practice Address - Fax:207-363-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty