Provider Demographics
NPI:1568728756
Name:YUE, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:YUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PAOLI PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1852
Mailing Address - Country:US
Mailing Address - Phone:610-644-8815
Mailing Address - Fax:610-644-9248
Practice Address - Street 1:23 PAOLI PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1852
Practice Address - Country:US
Practice Address - Phone:610-644-8815
Practice Address - Fax:610-644-9248
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030478L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist