Provider Demographics
NPI:1447792189
Name:YANGDDSPLLC
Entity Type:Organization
Organization Name:YANGDDSPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MENGCHI
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9980-202-5696
Mailing Address - Street 1:2221 DEER MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7265
Mailing Address - Country:US
Mailing Address - Phone:980-202-5696
Mailing Address - Fax:980-434-0504
Practice Address - Street 1:2221 DEER MEADOWS DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7265
Practice Address - Country:US
Practice Address - Phone:980-202-5696
Practice Address - Fax:980-434-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9853261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9853OtherDENTAL LIC#