MEDICARE: YU DENTAL GROUP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1306588785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YU DENTAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	3901 QUARTERHORSE RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-6192
Country	:	US
Telephone Number	:	517-366-0113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2843 E GRAND RIVER AVE STE 130
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4989
Country	:	US
Telephone Number	:	657-888-2693
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BOYD KING TUNG YU
Credential	:	D.M.D.
Telephone Number	:	657-888-2693

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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