Provider Demographics
NPI:1407098056
Name:YEUNG, ROBERT S (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:YEUNG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:950 TRADE CENTRE WAY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-0487
Mailing Address - Country:US
Mailing Address - Phone:269-349-2189
Mailing Address - Fax:269-349-2663
Practice Address - Street 1:950 TRADE CENTRE WAY
Practice Address - Street 2:SUITE 225
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-0487
Practice Address - Country:US
Practice Address - Phone:269-349-2189
Practice Address - Fax:269-349-2663
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-28
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist