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General NPI Number Information
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NPI Number | 1306588785
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Entity Type | Organization
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Legal Business Name | YU DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 04/07/2022
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 2843 E GRAND RIVER AVE STE 130
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City | EAST LANSING
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State | MI
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Zip | 48823-4989
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Country | US
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Telephone | 657-888-2693
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 QUARTERHORSE RD
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City | EAST LANSING
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State | MI
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Zip | 48823-6192
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Country | US
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Telephone | 517-366-0113
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOYD KING TUNG YU
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Credential | D.M.D.
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Telephone | 657-888-2693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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