Provider Demographics
NPI:1063013936
Name:YANG, KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:YANG
Suffix:
Gender:M
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:DENTAL DREAMS 68 STAFFORD ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1450
Mailing Address - Country:US
Mailing Address - Phone:424-274-1609
Mailing Address - Fax:
Practice Address - Street 1:DENTAL DREAMS 68 STAFFORD STREET
Practice Address - Street 2:
Practice Address - City:WORCESTOR
Practice Address - State:MA
Practice Address - Zip Code:01603
Practice Address - Country:US
Practice Address - Phone:424-274-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN1858874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program