Provider Demographics
NPI:1730305772
Name:YOON, ANTHONY Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:Y
Last Name:YOON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GRAY STONE LANE
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081
Mailing Address - Country:US
Mailing Address - Phone:214-632-0487
Mailing Address - Fax:817-924-7646
Practice Address - Street 1:2717 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-3041
Practice Address - Country:US
Practice Address - Phone:817-924-7670
Practice Address - Fax:817-924-7646
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist