Healthcare Provider Details

I. General information

NPI: 1396196200
Provider Name (Legal Business Name): WEI YAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 SCHAEFER RD
DEARBORN MI
48126-3249
US

IV. Provider business mailing address

5050 SCHAEFER RD
DEARBORN MI
48126-3249
US

V. Phone/Fax

Practice location:
  • Phone: 313-582-8150
  • Fax: 313-582-0745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberM333276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: