Healthcare Provider Details

I. General information

NPI: 1740145960
Provider Name (Legal Business Name): BEYOND TEETH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STATE ST
MAUSTON WI
53948-1746
US

IV. Provider business mailing address

510 E STATE ST
MAUSTON WI
53948-1746
US

V. Phone/Fax

Practice location:
  • Phone: 608-847-5614
  • Fax: 608-847-7265
Mailing address:
  • Phone: 608-847-5614
  • Fax: 608-847-7265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MA MARCIE YANG
Title or Position: DENTIST
Credential: DDS
Phone: 920-912-7161