Provider Demographics
NPI:1366875312
Name:BETHEA, YVONNE LYNETTE (RDH)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:LYNETTE
Last Name:BETHEA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 HIGH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1004
Mailing Address - Country:US
Mailing Address - Phone:702-419-2694
Mailing Address - Fax:
Practice Address - Street 1:6900 NORTH PECOS ROAD
Practice Address - Street 2:ROOM 5D-215
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:702-791-9314
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3537124Q00000X
MD4458124Q00000X
NJ22HI00800300124Q00000X
NY020810-1124Q00000X
VA0402205892124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist