Provider Demographics
NPI:1811686256
Name:LI, YAOXI (DMD)
Entity type:Individual
Prefix:
First Name:YAOXI
Middle Name:
Last Name:LI
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 1:111 NORWAY ST APT 404
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3413
Mailing Address - Country:US
Mailing Address - Phone:207-877-5148
Mailing Address - Fax:
Practice Address - Street 1:2260 MAIN ST
Practice Address - Street 2:
Practice Address - City:W BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02668-1110
Practice Address - Country:US
Practice Address - Phone:207-877-5148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18597511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice