Basic Information
| Provider Information | |||||||||
| NPI: | 1104089820 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YU | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 S IRVING HEIGHTS DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750606237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724453600 | ||||||||
| FaxNumber: | 9727851223 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 S IRVING HEIGHTS DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750606237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724453600 | ||||||||
| FaxNumber: | 9727851223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2008 | ||||||||
| LastUpdateDate: | 02/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 31839 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.