Provider Demographics
NPI:1306100607
Name:YANG, WEIDONG (DMD)
Entity type:Individual
Prefix:DR
First Name:WEIDONG
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FIRETHORN CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4908
Mailing Address - Country:US
Mailing Address - Phone:302-893-6989
Mailing Address - Fax:
Practice Address - Street 1:4133 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4168
Practice Address - Country:US
Practice Address - Phone:302-893-6989
Practice Address - Fax:215-389-3876
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0391341223G0001X
DEG1-0001354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAYANGWDMedicaid
DEYANGWDMedicaid
PAYANGWDMedicare Oscar/Certification
PAYANGWDMedicaid
PAYANGWDMedicare PIN
PAYANGWDMedicare UPIN
DEYANGWDMedicare Oscar/Certification
PA8952616010Medicare NSC
DEYANGWDMedicaid