Amanda Yacoub

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401418068 Issued in VA

Practice address

11107 Sunset Hills Rd Ste 111
Reston, VA 20190-5481

Phone

(703) 860-3200

NPI assigned

Mar 16, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fusion Dental

  • Dentist
  • Reston, VA
  • NPI 1508445644
  NPD
• Reston Dental Group, PC

  • Dental Clinic/Center
  • Reston, VA
  • NPI 1427128669
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1336724897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11107 SUNSET HILLS RD STE 111",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905481",
            "telephone_number": "703-860-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11107 SUNSET HILLS RD STE 111",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905481",
            "telephone_number": "703-860-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YACOUB",
        "first_name": "AMANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-16",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DC",
            "license": "DEN2000168",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401418068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Marie Woodruff, RN
• Cathy Woodrum
• Kara Lynne Wright
• Kellan Wright
• Michelle Wu
• Gary Yang
• Olivia Yellen
• Baris Yildirim, M.D.
• Wing Y Yip, PHARM.D.
• Korey Yngstrom

• General Practice Dentistry in Reston, VA
• Providers in Reston, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.