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General NPI Number Information
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NPI Number | 1669851259
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Entity Type | Individual
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Provider Name | MALISA YU D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 3300 KEMP RD
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City | BEAVERCREEK
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State | OH
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Zip | 45431-4200
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Country | US
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Telephone | 937-426-2653
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E 15TH ST. SUITE #520
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City | FORT WORTH
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State | TX
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Zip | 76102
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Country | US
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Telephone | 817-529-8151
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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 | 30.027626
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License Number State | OH
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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 | 32596
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15851
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License Number State | MD
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