Provider Demographics
NPI:1831857788
Name:SEDATION AND IMPLANT DENSTISTRY - DR ANDERSON AND DR YANG PLLC
Entity type:Organization
Organization Name:SEDATION AND IMPLANT DENSTISTRY - DR ANDERSON AND DR YANG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-735-4661
Mailing Address - Street 1:1815 SUBURBAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4380
Mailing Address - Country:US
Mailing Address - Phone:651-735-4661
Mailing Address - Fax:651-735-4661
Practice Address - Street 1:1815 SUBURBAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4380
Practice Address - Country:US
Practice Address - Phone:651-735-4661
Practice Address - Fax:651-735-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty