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General NPI Number Information
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NPI Number | 1760979058
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Entity Type | Organization
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Legal Business Name | DREAM FAMILY DENTAL - SHIN YOUNG YANG, DMD, LLC
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 45 E US ROUTE 22 & 3
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City | MAINEVILLE
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State | OH
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Zip | 45039
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Country | US
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Telephone | 513-305-2085
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Fax |
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Provider Business Mailing Address
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Address Line | 4543 ESTATE CT
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City | MASON
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State | OH
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Zip | 45040-2968
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Country | US
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Telephone | 513-305-2085
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHIN YOUNG YANG
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Credential | DMD
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Telephone | 513-305-2085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 30022610
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License Number State | OH
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