Healthcare Provider Details

I. General information

NPI: 1326860685
Provider Name (Legal Business Name): YIDI ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 WYNDHAM WAY STE B
WEST LAFAYETTE IN
47906-5508
US

IV. Provider business mailing address

3451 WYNDHAM WAY STE B
WEST LAFAYETTE IN
47906-5508
US

V. Phone/Fax

Practice location:
  • Phone: 650-918-0918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YIDI LIU
Title or Position: OWNER
Credential:
Phone: 765-801-0808