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General NPI Number Information
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NPI Number | 1528733920
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Entity Type | Individual
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Provider Name | MINSOO YEO DMD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 2015 INTERSTATE DR
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City | OPELIKA
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State | AL
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Zip | 36801-5415
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Country | US
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Telephone | 334-203-2740
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Fax |
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Provider Business Mailing Address
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Address Line | 700 W MAGNOLIA AVE APT X6
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City | AUBURN
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State | AL
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Zip | 36832-4539
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Country | US
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Telephone | 334-220-4441
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN122524
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-0006957-C1
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License Number State | AL
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