Provider Demographics
NPI:1942946561
Name:QI, YAO (DMD)
Entity Type:Individual
Prefix:
First Name:YAO
Middle Name:
Last Name:QI
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 1:1201 BROADWAY SPC E215
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-4276
Mailing Address - Country:US
Mailing Address - Phone:617-756-1928
Mailing Address - Fax:888-832-8267
Practice Address - Street 1:1201 BROADWAY SPC E215
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4276
Practice Address - Country:US
Practice Address - Phone:617-756-1928
Practice Address - Fax:888-832-8267
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859400122300000X
390200000X
IL019.034033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program