Healthcare Provider Details

I. General information

NPI: 1831281112
Provider Name (Legal Business Name): BEXTER M YANG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10251 TORRE AVE SUITE 100
CUPERTINO CA
95014-2186
US

IV. Provider business mailing address

10251 TORRE AVE SUITE 100
CUPERTINO CA
95014-2186
US

V. Phone/Fax

Practice location:
  • Phone: 408-252-8833
  • Fax: 408-252-8881
Mailing address:
  • Phone: 408-252-8833
  • Fax: 408-252-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number44643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: