MEDICARE: MICHAEL L. YANG, D.D.S., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	014666	MO

General Provider Information

NPI Number	:	1912062449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL L. YANG, D.D.S., LLC

Provider Business Mailing Address
First Line	:	ONE WESTBURY SQUARE
Second Line	:	#230
City	:	ST. CHARLES
State	:	MO
Zip	:	63301
Country	:	US
Telephone Number	:	636-947-1057
Fax Number	:	636-723-1627

Provider Business Practice Location Address
First Line	:	1 WESTBURY DR
Second Line	:	#230
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2541
Country	:	US
Telephone Number	:	636-947-1057
Fax Number	:	636-723-1627

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL LEO YANG
Credential	:	D.D.S.
Telephone Number	:	636-947-1057

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	08/22/2020

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