Healthcare Provider Details

I. General information

NPI: 1477018794
Provider Name (Legal Business Name): YANG ZHOU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 STATE HIGHWAY 30 STE 100
AMSTERDAM NY
12010-7567
US

IV. Provider business mailing address

4930 STATE HIGHWAY 30 STE 100
AMSTERDAM NY
12010-7567
US

V. Phone/Fax

Practice location:
  • Phone: 518-842-9500
  • Fax:
Mailing address:
  • Phone: 518-842-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number061274
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: