Provider Demographics
NPI:1932754215
Name:DHAITI, YOLENE
Entity Type:Individual
Prefix:
First Name:YOLENE
Middle Name:
Last Name:DHAITI
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 1:1834 HARTMAN LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2534
Mailing Address - Country:US
Mailing Address - Phone:707-338-3370
Mailing Address - Fax:
Practice Address - Street 1:1381 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448
Practice Address - Country:US
Practice Address - Phone:707-433-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19826124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist