Provider Demographics
NPI:1851571210
Name:YU, TIMOTHY (DMD, MS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N 50TH ST
Mailing Address - Street 2:PHOENIX
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3030 N 50TH ST
Practice Address - Street 2:PHOENIX
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7962
Practice Address - Country:US
Practice Address - Phone:201-744-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD076121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics