Provider Demographics
NPI:1225570559
Name:MARY ANNE M. YU, DMD, INC.
Entity Type:Organization
Organization Name:MARY ANNE M. YU, DMD, INC.
Other - Org Name:MY DENTAL PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:MAIPID
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-938-6937
Mailing Address - Street 1:1269 W EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1028
Mailing Address - Country:US
Mailing Address - Phone:650-938-6937
Mailing Address - Fax:650-938-6702
Practice Address - Street 1:1269 W EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1028
Practice Address - Country:US
Practice Address - Phone:650-938-6937
Practice Address - Fax:650-938-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52641261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental