Provider Demographics
NPI:1912062449
Name:MICHAEL L. YANG, D.D.S., LLC
Entity Type:Organization
Organization Name:MICHAEL L. YANG, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-947-1057
Mailing Address - Street 1:ONE WESTBURY SQUARE
Mailing Address - Street 2:#230
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301
Mailing Address - Country:US
Mailing Address - Phone:636-947-1057
Mailing Address - Fax:636-723-1627
Practice Address - Street 1:1 WESTBURY DR
Practice Address - Street 2:#230
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2541
Practice Address - Country:US
Practice Address - Phone:636-947-1057
Practice Address - Fax:636-723-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0146661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty