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General NPI Number Information
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NPI Number | 1609220490
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Entity Type | Organization
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Legal Business Name | KWANGJAE YEO DDS PLLC
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 1894 ROYAL LN SUITE 104
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City | DALLAS
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State | TX
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Zip | 75229-3182
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Country | US
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Telephone | 469-703-9819
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Fax |
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Provider Business Mailing Address
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Address Line | 1894 ROYAL LN SUITE 104
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City | DALLAS
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State | TX
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Zip | 75229-3182
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Country | US
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Telephone | 469-703-9819
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KWANGJAE YEO
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Credential | DDS
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Telephone | 469-703-9819
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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 | 29206
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License Number State | TX
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