Healthcare Provider Details

I. General information

NPI: 1396316824
Provider Name (Legal Business Name): SIREEN YANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S DETROIT ST
LAGRANGE IN
46761-2314
US

IV. Provider business mailing address

11722 ALLISONVILLE ROAD STE 103 #394
FISHERS IN
46038
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12013220A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: