Healthcare Provider Details

I. General information

NPI: 1255380994
Provider Name (Legal Business Name): VICTOR JAMTOON YEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5877 LIVERNOIS RD SUITE 102
TROY MI
48098-3100
US

IV. Provider business mailing address

5877 LIVERNOIS RD SUITE 102
TROY MI
48098-3100
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-9985
  • Fax: 248-879-9810
Mailing address:
  • Phone: 248-879-9985
  • Fax: 248-879-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901010929
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: