Healthcare Provider Details

I. General information

NPI: 1447453899
Provider Name (Legal Business Name): DANA ANTHONY YIP D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18676 WILLAMETTE DR SUITE 301
WEST LINN OR
97068-1718
US

IV. Provider business mailing address

18676 WILLAMETTE DR SUITE 301
WEST LINN OR
97068-1718
US

V. Phone/Fax

Practice location:
  • Phone: 503-697-4746
  • Fax: 503-635-0035
Mailing address:
  • Phone: 503-697-4746
  • Fax: 503-635-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD7836
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: