Provider Demographics
NPI:1447642756
Name:YOON, DOUGLAS (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:YOON
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 SPARTA WAY STE B
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-2001
Mailing Address - Country:US
Mailing Address - Phone:706-899-3002
Mailing Address - Fax:
Practice Address - Street 1:2312 SPARTA WAY STE B
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-2001
Practice Address - Country:US
Practice Address - Phone:706-899-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN0150101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program