Provider Demographics
NPI:1801927173
Name:YAO, GRACE SOONJUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:SOONJUNG
Last Name:YAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ROUNDHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2100
Mailing Address - Country:US
Mailing Address - Phone:410-752-0657
Mailing Address - Fax:
Practice Address - Street 1:210 ROUNDHOUSE CT
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2100
Practice Address - Country:US
Practice Address - Phone:410-752-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice