Provider Demographics
NPI:1891460424
Name:YOO, ANDY (DDS)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:YOO
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:USA DENTAL HEALTH ACTIVITY
Mailing Address - Street 2:4301 WILSON ST.
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503
Mailing Address - Country:US
Mailing Address - Phone:580-558-2795
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAL HEALTH ACTIVITY
Practice Address - Street 2:4301 WILSON ST.
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-558-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist