Provider Demographics
NPI:1073671301
Name:POWELL & YUN DDS PLLC
Entity Type:Organization
Organization Name:POWELL & YUN DDS PLLC
Other - Org Name:PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SM
Authorized Official - Last Name:YUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-347-0777
Mailing Address - Street 1:4111 OKEMOS ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864
Mailing Address - Country:US
Mailing Address - Phone:517-347-0777
Mailing Address - Fax:517-347-8788
Practice Address - Street 1:4111 OKEMOS ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864
Practice Address - Country:US
Practice Address - Phone:517-347-0777
Practice Address - Fax:517-347-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI014798122300000X
MI017212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty