Healthcare Provider Details

I. General information

NPI: 1962997023
Provider Name (Legal Business Name): YIN CAO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E 5TH ST
SUPERIOR WI
54880-3709
US

IV. Provider business mailing address

2222 E 5TH ST
SUPERIOR WI
54880-3709
US

V. Phone/Fax

Practice location:
  • Phone: 715-392-1955
  • Fax: 715-392-1935
Mailing address:
  • Phone: 715-392-1955
  • Fax: 715-392-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD14049
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1001930-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: