Provider Demographics
NPI:1932249802
Name:WINNIE YU, DMD, PC
Entity Type:Organization
Organization Name:WINNIE YU, DMD, PC
Other - Org Name:WINNIE YU, DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WINNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-632-0148
Mailing Address - Street 1:110 WEST ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2120
Mailing Address - Country:US
Mailing Address - Phone:978-632-0148
Mailing Address - Fax:
Practice Address - Street 1:110 WEST ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2120
Practice Address - Country:US
Practice Address - Phone:978-632-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA183231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty