Provider Demographics
NPI:1518221407
Name:YU, WENJIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:WENJIE
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:WENJIE
Other - Middle Name:
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:12 N MAIN ST STE 101
Mailing Address - Street 2:101
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1932
Mailing Address - Country:US
Mailing Address - Phone:860-236-4249
Mailing Address - Fax:860-236-4249
Practice Address - Street 1:12 N MAIN ST STE 101
Practice Address - Street 2:101
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1932
Practice Address - Country:US
Practice Address - Phone:860-236-4249
Practice Address - Fax:860-236-4249
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0107671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004011136Medicaid