Provider Demographics
NPI:1316277973
Name:YANG, MA MARCIE (DDS)
Entity type:Individual
Prefix:
First Name:MA
Middle Name:MARCIE
Last Name:YANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:510 E STATE ST
Mailing Address - Street 2:APT. 201
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-1746
Mailing Address - Country:US
Mailing Address - Phone:608-847-5614
Mailing Address - Fax:608-847-7265
Practice Address - Street 1:515 DELAWARE ST SE
Practice Address - Street 2:9-176 MOOS HEALTH SCIENCE TOWER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0357
Practice Address - Country:US
Practice Address - Phone:612-624-3254
Practice Address - Fax:612-626-2655
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2016-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI6765-151223P0700X
MND127401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0700XDental ProvidersDentistProsthodontics