Healthcare Provider Details

I. General information

NPI: 1104949593
Provider Name (Legal Business Name): MICHAEL DAVID YUEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD SUITE 208
ROCHESTER HILLS MI
48309-1768
US

IV. Provider business mailing address

1460 WALTON BLVD SUITE 208
ROCHESTER HILLS MI
48309-1768
US

V. Phone/Fax

Practice location:
  • Phone: 248-656-1626
  • Fax:
Mailing address:
  • Phone: 248-656-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901020172
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: