Provider Demographics
NPI:1578976577
Name:YES DENTAL
Entity Type:Organization
Organization Name:YES DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KATI
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-962-0173
Mailing Address - Street 1:3109 N BELT LINE RD
Mailing Address - Street 2:110
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6867
Mailing Address - Country:US
Mailing Address - Phone:214-962-0173
Mailing Address - Fax:
Practice Address - Street 1:3109 N BELT LINE RD
Practice Address - Street 2:110
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6867
Practice Address - Country:US
Practice Address - Phone:214-962-0173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28721122300000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Yes122300000XDental ProvidersDentistGroup - Single Specialty