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General NPI Number Information
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NPI Number | 1396316824
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Entity Type | Individual
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Provider Name | SIREEN YANG DDS
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Gender | Female
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 612 S DETROIT ST
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City | LAGRANGE
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State | IN
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Zip | 46761-2314
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Country | US
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Telephone | 260-463-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 11722 ALLISONVILLE ROAD STE 103 #394
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City | FISHERS
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State | IN
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Zip | 46038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12013220A
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License Number State | IN
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