Provider Demographics
NPI:1003362062
Name:YOU, TAE EUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAE
Middle Name:EUN
Last Name:YOU
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 1:8179 MIDTOWN BLVD
Mailing Address - Street 2:APT 6201
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4574
Mailing Address - Country:US
Mailing Address - Phone:415-317-3322
Mailing Address - Fax:
Practice Address - Street 1:1515 S BUCKNER BLVD
Practice Address - Street 2:STE 223
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-1760
Practice Address - Country:US
Practice Address - Phone:214-391-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX323371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice