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General NPI Number Information
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NPI Number | 1407237407
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Entity Type | Individual
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Provider Name | MATTHEW MASARU ANBE YEN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 11110 FORT ST #106
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City | OMAHA
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State | NE
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Zip | 68164-2183
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Country | US
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Telephone | 402-492-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 3430 WEBSTER ST
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City | OMAHA
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State | NE
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Zip | 68131-1950
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Country | US
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Telephone | 808-728-5519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7216
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License Number State | NE
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