Provider Demographics
NPI:1982029195
Name:ALPHA DENTAL-BROAD-MING YU D.D.S.,LLC
Entity Type:Organization
Organization Name:ALPHA DENTAL-BROAD-MING YU D.D.S.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTAILING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-853-3232
Mailing Address - Street 1:4770 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1613
Mailing Address - Country:US
Mailing Address - Phone:614-853-3232
Mailing Address - Fax:614-853-1313
Practice Address - Street 1:4770 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1613
Practice Address - Country:US
Practice Address - Phone:614-853-3232
Practice Address - Fax:614-853-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty