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General NPI Number Information
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NPI Number | 1780996801
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Entity Type | Individual
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Provider Name | JASON THOMAS LUE YEN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 226 STEVEN B TANGER BLVD
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City | COMMERCE
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State | GA
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Zip | 30529-3571
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Country | US
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Telephone | 706-423-9291
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 459
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City | COLBERT
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State | GA
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Zip | 30628-0459
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Country | US
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Telephone | 706-788-3234
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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 | DN19149
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License Number State | FL
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