Provider Demographics
NPI:1265046114
Name:YOON, OLIVIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 CONGRESS AVE APT 235
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2613
Mailing Address - Country:US
Mailing Address - Phone:785-393-8320
Mailing Address - Fax:
Practice Address - Street 1:8062 FERGUSON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-5848
Practice Address - Country:US
Practice Address - Phone:214-200-4209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist