Healthcare Provider Details

I. General information

NPI: 1205559119
Provider Name (Legal Business Name): YAYA DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 BIGELOW AVE
WATERTOWN MA
02472-2009
US

IV. Provider business mailing address

19 STRATHAM RD
LEXINGTON MA
02421-4508
US

V. Phone/Fax

Practice location:
  • Phone: 617-924-6422
  • 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: DR. YANG HU
Title or Position: MANAGER
Credential: DMD
Phone: 405-821-1932