Healthcare Provider Details

I. General information

NPI: 1285296665
Provider Name (Legal Business Name): EDWARD YAO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 BALTIMORE PIKE
SPRINGFIELD PA
19064-3811
US

IV. Provider business mailing address

11 PIN OAK DR
CHADDS FORD PA
19317-7386
US

V. Phone/Fax

Practice location:
  • Phone: 610-572-4627
  • Fax:
Mailing address:
  • Phone: 610-500-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS042319
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: