Provider Demographics
NPI:1306973599
Name:YANG, EDWARD E (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:YANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 E CENTRAL TEXAS EXPY
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-9126
Mailing Address - Country:US
Mailing Address - Phone:254-690-7997
Mailing Address - Fax:254-690-8444
Practice Address - Street 1:1203 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9126
Practice Address - Country:US
Practice Address - Phone:254-690-7997
Practice Address - Fax:254-690-8444
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice