Provider Demographics
NPI:1912646001
Name:ZHANG, YAN (DMD)
Entity type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WATERPOINT RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7300
Mailing Address - Country:US
Mailing Address - Phone:859-489-4827
Mailing Address - Fax:
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-8968
Practice Address - Country:US
Practice Address - Phone:910-893-1096
Practice Address - Fax:910-814-1559
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice