MEDICARE: DR. TAE EUN YOU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	32337	TX

General Provider Information

NPI Number	:	1003362062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAE EUN YOU DDS

Provider Business Mailing Address
First Line	:	8179 MIDTOWN BLVD
Second Line	:	APT 6201
City	:	DALLAS
State	:	TX
Zip	:	75231-4574
Country	:	US
Telephone Number	:	415-317-3322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 S BUCKNER BLVD
Second Line	:	STE 223
City	:	DALLAS
State	:	TX
Zip	:	75217-1760
Country	:	US
Telephone Number	:	214-391-6868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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