Jonathan Yang, DDS
Individual provider Active NPI General Practice Dentistry · Lapine, OR
NPI 1003082652 · NPPES record last updated May 5, 2008
Key facts
- NPI
- 1003082652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D7823 (OR)
- Practice address
- 16475 Bluewood PL
Lapine, OR 97739 - Phone
- (541) 536-0264
- Fax
- (541) 536-0266
- NPI assigned
- May 5, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 31, 2016 through Mar 31, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D7823 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Dental Group, PC-Lapine | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D7823 | OR | Yes |
Addresses
Primary practice location
16475 Bluewood PL
Lapine, OR 97739
Mailing address
PO Box 2999
16475 Bluewood PL
La Pine, OR 97739-2999
Phone (541) 536-0264
Other providers in Lapine, OR
All providers in Lapine, OR · General Practice Dentistry in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.