Provider Demographics
NPI:1477708261
Name:Y & P FAMILY DENTISTRY
Entity Type:Organization
Organization Name:Y & P FAMILY DENTISTRY
Other - Org Name:ADVANCED DENTISTRY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-795-9100
Mailing Address - Street 1:38800 RYAN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2993
Mailing Address - Country:US
Mailing Address - Phone:586-795-9100
Mailing Address - Fax:586-795-9110
Practice Address - Street 1:38800 RYAN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2993
Practice Address - Country:US
Practice Address - Phone:586-795-9100
Practice Address - Fax:586-795-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010169791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4414051Medicaid