Healthcare Provider Details

I. General information

NPI: 1023106333
Provider Name (Legal Business Name): EFFIE C YAO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 W LAKE MARY BLVD STE 230
LAKE MARY FL
32746-2403
US

IV. Provider business mailing address

4106 W LAKE MARY BLVD STE 230
LAKE MARY FL
32746-2403
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-0881
  • Fax: 407-333-2893
Mailing address:
  • Phone: 407-333-0881
  • Fax: 407-333-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN12228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: