Provider Demographics
NPI:1023893443
Name:SUKBUM YOO DENTAL PLLC
Entity type:Organization
Organization Name:SUKBUM YOO DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUKBUM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-345-3010
Mailing Address - Street 1:1 EXECUTIVE DR APT 302
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3340
Mailing Address - Country:US
Mailing Address - Phone:812-345-3010
Mailing Address - Fax:
Practice Address - Street 1:175 FROEHLICH FARM BLVD STE 169
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2920
Practice Address - Country:US
Practice Address - Phone:516-325-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty