Provider Demographics
NPI:1184516056
Name:HEO, YOUNGHYE (DMD)
Entity type:Individual
Prefix:
First Name:YOUNGHYE
Middle Name:
Last Name:HEO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 DADRIAN CT
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1678
Mailing Address - Country:US
Mailing Address - Phone:618-541-9854
Mailing Address - Fax:
Practice Address - Street 1:2800 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4700
Practice Address - Country:US
Practice Address - Phone:618-474-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019036269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist