Provider Demographics
NPI:1174195192
Name:YUN, OLIVER (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:
Last Name:YUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 S MANGUM ST APT 1094
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1006
Mailing Address - Country:US
Mailing Address - Phone:714-293-3134
Mailing Address - Fax:
Practice Address - Street 1:350 N COX ST STE 18
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5514
Practice Address - Country:US
Practice Address - Phone:336-625-4216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice