Provider Demographics
NPI:1891677951
Name:MEDINA, YURY NATALIA
Entity type:Individual
Prefix:
First Name:YURY
Middle Name:NATALIA
Last Name:MEDINA
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 1:108 GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-2129
Mailing Address - Country:US
Mailing Address - Phone:857-206-2628
Mailing Address - Fax:857-206-2628
Practice Address - Street 1:108 GENEVA ST
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-2129
Practice Address - Country:US
Practice Address - Phone:857-206-2628
Practice Address - Fax:857-206-2628
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADA03071126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant