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General NPI Number Information
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NPI Number | 1770946931
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Entity Type | Organization
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Legal Business Name | YELLOW BEAR PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 331 KNICKERBOCKER AVE SUITE 3B
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City | BROOKLYN
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State | NY
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Zip | 11237-3601
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Country | US
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Telephone | 717-201-8047
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Fax |
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Provider Business Mailing Address
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Address Line | 1471 DEKALB AVE FL 3B
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City | BROOKLYN
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State | NY
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Zip | 11237-3895
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Country | US
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Telephone |
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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. HAI DO
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Credential | D.D.S.
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Telephone | 717-201-8047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 056718
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License Number State | NY
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