Healthcare Provider Details

I. General information

NPI: 1831774512
Provider Name (Legal Business Name): YINGYING ZHANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2021
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 TOLLAND TPKE STE 1C
MANCHESTER CT
06042-1759
US

IV. Provider business mailing address

5 URBAN LN
NEWINGTON CT
06111-3158
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-1429
  • Fax:
Mailing address:
  • Phone: 860-805-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number14020
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13115
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: