Healthcare Provider Details

I. General information

NPI: 1760220768
Provider Name (Legal Business Name): ADDI A YIN BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR RM D1-85
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

9927 NW 18TH RD
GAINESVILLE FL
32606-9250
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6775
  • Fax:
Mailing address:
  • Phone: 626-623-9379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDRPM2506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: