Provider Demographics
NPI:1780968412
Name:YANG, MICHAEL LEO (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEO
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 1:1 WESTBURY DR STE 230
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2561
Mailing Address - Country:US
Mailing Address - Phone:636-947-1057
Mailing Address - Fax:636-723-1627
Practice Address - Street 1:1 WESTBURY DR STE 230
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2561
Practice Address - Country:US
Practice Address - Phone:636-947-1057
Practice Address - Fax:636-723-1627
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist