Provider Demographics
NPI:1740689421
Name:YAN, DONG (DDS)
Entity type:Individual
Prefix:
First Name:DONG
Middle Name:
Last Name:YAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 BELLAIRE BLVD
Mailing Address - Street 2:B-23
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2545
Mailing Address - Country:US
Mailing Address - Phone:281-568-3985
Mailing Address - Fax:
Practice Address - Street 1:11205 BELLAIRE BLVD
Practice Address - Street 2:B-23
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2545
Practice Address - Country:US
Practice Address - Phone:281-568-3985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA637821223G0001X
TX314391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice