Provider Demographics
NPI:1871629949
Name:XU, ANDREW YUJUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:YUJUN
Last Name:XU
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 1:2333 SUNSHINE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-7636
Mailing Address - Country:US
Mailing Address - Phone:646-662-3105
Mailing Address - Fax:
Practice Address - Street 1:11501 CUSTER RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0000
Practice Address - Country:US
Practice Address - Phone:972-369-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice