Healthcare Provider Details

I. General information

NPI: 1982712428
Provider Name (Legal Business Name): DONALD YEE-YICK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 COPE AVE E
MAPLEWOOD MN
55109
US

IV. Provider business mailing address

1270 COPE AVE E
MAPLEWOOD MN
55109
US

V. Phone/Fax

Practice location:
  • Phone: 651-482-8332
  • Fax: 651-482-7839
Mailing address:
  • Phone: 651-482-8332
  • Fax: 651-482-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11105
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: