Healthcare Provider Details

I. General information

NPI: 1073908349
Provider Name (Legal Business Name): TONY YANG DDS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 PENROSE PL STE 106
BOULDER CO
80301-1809
US

IV. Provider business mailing address

3400 PENROSE PL STE 106
BOULDER CO
80301-1809
US

V. Phone/Fax

Practice location:
  • Phone: 303-604-9393
  • Fax: 303-442-3878
Mailing address:
  • Phone: 303-604-9393
  • Fax: 303-442-3878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberOMS84
License Number StateCA

VIII. Authorized Official

Name: TONY YANG
Title or Position: MD
Credential: M.D.
Phone: 949-393-5789