Provider Demographics
NPI:1518176403
Name:YU, SANGMO DANNIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANGMO
Middle Name:DANNIE
Last Name:YU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANNIE
Other - Middle Name:SANGMO
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2205 WILLIAMS TRACE BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4514
Mailing Address - Country:US
Mailing Address - Phone:281-240-5559
Mailing Address - Fax:281-240-5557
Practice Address - Street 1:2205 WILLIAMS TRACE BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4514
Practice Address - Country:US
Practice Address - Phone:281-240-5559
Practice Address - Fax:281-240-5557
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1844755Medicaid