Provider Demographics
NPI:1043439490
Name:YAO, YUAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:YUAN
Middle Name:
Last Name:YAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:MA
Mailing Address - Zip Code:01775-1612
Mailing Address - Country:US
Mailing Address - Phone:978-897-9879
Mailing Address - Fax:978-897-9879
Practice Address - Street 1:249 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-2804
Practice Address - Country:US
Practice Address - Phone:978-621-5084
Practice Address - Fax:978-264-9737
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice