Provider Demographics
NPI:1144534454
Name:YANOVER, MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:YANOVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 E FORDHAM RD
Mailing Address - Street 2:FORDHAM PLAZA DENTAL ASSOCIATES
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5108
Mailing Address - Country:US
Mailing Address - Phone:718-365-4300
Mailing Address - Fax:
Practice Address - Street 1:466 E FORDHAM RD
Practice Address - Street 2:FORDHAM PLAZA DENTAL ASSOCIATES
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5108
Practice Address - Country:US
Practice Address - Phone:718-365-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055787-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice