Provider Demographics
NPI:1013125269
Name:DO, YOUNG TAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:TAE
Last Name:DO
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 1:99 NEW BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-4114
Mailing Address - Country:US
Mailing Address - Phone:201-384-5941
Mailing Address - Fax:
Practice Address - Street 1:99 NEW BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4114
Practice Address - Country:US
Practice Address - Phone:201-384-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ120691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice