Provider Demographics
NPI:1508011016
Name:YEN, GREGORY CALVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CALVIN
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 1:16006 MILITARY RD S
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3007
Mailing Address - Country:US
Mailing Address - Phone:206-243-5740
Mailing Address - Fax:206-243-5952
Practice Address - Street 1:16006 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-3007
Practice Address - Country:US
Practice Address - Phone:206-243-5740
Practice Address - Fax:206-243-5952
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA70951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice