Provider Demographics
NPI:1699221408
Name:YU, HARIS (DMD)
Entity Type:Individual
Prefix:
First Name:HARIS
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 1:10 WHIPPOORWILL LANE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01721
Mailing Address - Country:US
Mailing Address - Phone:626-389-7868
Mailing Address - Fax:
Practice Address - Street 1:6525 N DECATUR BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2993
Practice Address - Country:US
Practice Address - Phone:702-577-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV69451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice