Healthcare Provider Details

I. General information

NPI: 1083414791
Provider Name (Legal Business Name): BO YANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 UNION ST OFC 3
MARLBOROUGH MA
01752-1207
US

IV. Provider business mailing address

99 E DEDHAM ST APT 916
BOSTON MA
02118-5034
US

V. Phone/Fax

Practice location:
  • Phone: 508-970-6940
  • Fax:
Mailing address:
  • Phone: 917-880-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001377
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: