Provider Demographics
NPI:1316467483
Name:XU, YENAN (DDS)
Entity type:Individual
Prefix:DR
First Name:YENAN
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4267 TOURNETTE DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-9228
Mailing Address - Country:US
Mailing Address - Phone:347-963-3531
Mailing Address - Fax:
Practice Address - Street 1:1344 HIGHWAY 160 E STE 101
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7066
Practice Address - Country:US
Practice Address - Phone:803-650-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119971223G0001X
SC100311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice