Provider Demographics
NPI:1407237407
Name:YEN, MATTHEW MASARU ANBE (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MASARU ANBE
Last Name:YEN
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 1:3430 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1950
Mailing Address - Country:US
Mailing Address - Phone:808-728-5519
Mailing Address - Fax:
Practice Address - Street 1:11110 FORT ST
Practice Address - Street 2:#106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2183
Practice Address - Country:US
Practice Address - Phone:402-492-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist