Provider Demographics
NPI:1598828097
Name:YANG, BOBBY (DDS)
Entity Type:Individual
Prefix:
First Name:BOBBY
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 1:1728 W GLENDALE AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8864
Mailing Address - Country:US
Mailing Address - Phone:602-995-7336
Mailing Address - Fax:602-995-2665
Practice Address - Street 1:1728 W GLENDALE AVE STE 305
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8864
Practice Address - Country:US
Practice Address - Phone:602-995-7336
Practice Address - Fax:602-995-2665
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry