Healthcare Provider Details

I. General information

NPI: 1578620860
Provider Name (Legal Business Name): YUEY SANG MOY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YUEY S MOY DDS PC

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9652 PENNSYLVANIA AVE
UPPER MARLBORO MD
20772-3760
US

IV. Provider business mailing address

9652 PENNSYLVANIA AVE
UPPER MARLBORO MD
20772-3760
US

V. Phone/Fax

Practice location:
  • Phone: 301-599-0194
  • Fax: 301-599-9489
Mailing address:
  • Phone: 301-599-0194
  • Fax: 301-599-9489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8907
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: