Provider Demographics
NPI:1104189968
Name:YU, STEPHEN (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:YU
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 1:518 N GENERALS BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3500
Mailing Address - Country:US
Mailing Address - Phone:704-748-1110
Mailing Address - Fax:704-748-9747
Practice Address - Street 1:518 N GENERALS BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3500
Practice Address - Country:US
Practice Address - Phone:704-748-1110
Practice Address - Fax:704-748-9747
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist