Healthcare Provider Details

I. General information

NPI: 1174787923
Provider Name (Legal Business Name): EDMUND YEANG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24307 ALDINE WESTFIELD RD M
SPRING TX
77373-5955
US

IV. Provider business mailing address

24307 ALDINE WESTFIELD RD STE M
SPRING TX
77373-5955
US

V. Phone/Fax

Practice location:
  • Phone: 281-350-6500
  • Fax:
Mailing address:
  • Phone: 281-350-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14897
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: