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General NPI Number Information
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NPI Number | 1073671301
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Entity Type | Organization
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Legal Business Name | POWELL & YUN DDS PLLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4111 OKEMOS ROAD SUITE 202
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City | OKEMOS
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State | MI
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Zip | 48864
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Country | US
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Telephone | 517-347-0777
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Fax | 517-347-8788
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Provider Business Mailing Address
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Address Line | 4111 OKEMOS ROAD SUITE 202
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City | OKEMOS
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State | MI
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Zip | 48864
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Country | US
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Telephone | 517-347-0777
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Fax | 517-347-8788
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MATTHEW SM YUN
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Credential | DDS
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Telephone | 517-347-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 014798
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 017212
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License Number State | MI
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