Provider Demographics
NPI:1508910613
Name:YU, HOLMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOLMAN
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1617
Mailing Address - Country:US
Mailing Address - Phone:860-928-6533
Mailing Address - Fax:860-928-3356
Practice Address - Street 1:189 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1617
Practice Address - Country:US
Practice Address - Phone:860-928-6533
Practice Address - Fax:860-928-3356
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT92341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice