Healthcare Provider Details

I. General information

NPI: 1801241518
Provider Name (Legal Business Name): YAZHOU ZHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2016
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MILL ST
PRINCETON ME
04668-3344
US

IV. Provider business mailing address

136 MILL STREET
PRINCETON ME
04668-3043
US

V. Phone/Fax

Practice location:
  • Phone: 207-796-5503
  • Fax: 207-483-2525
Mailing address:
  • Phone: 207-796-5503
  • Fax: 207-483-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN4585
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN4585
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: