Provider Demographics
NPI:1275019655
Name:YAN, TONY YE (DDS)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:YE
Last Name:YAN
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:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-1340
Mailing Address - Country:US
Mailing Address - Phone:509-293-7826
Mailing Address - Fax:509-689-3247
Practice Address - Street 1:1015 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WA
Practice Address - Zip Code:98813
Practice Address - Country:US
Practice Address - Phone:509-686-0603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60865994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE60865994OtherLICENSE NUMBER