Provider Demographics
NPI:1104939438
Name:YUEN, ALEX WAH (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:WAH
Last Name:YUEN
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 1:3501 N BUTLER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6430
Mailing Address - Country:US
Mailing Address - Phone:505-564-4470
Mailing Address - Fax:505-325-9707
Practice Address - Street 1:3501 N BUTLER AVE STE 103
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6430
Practice Address - Country:US
Practice Address - Phone:505-564-4470
Practice Address - Fax:505-325-9707
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5306122300000X
NMDD54251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ525008OtherAHCCCP
AZAY1518589Medicaid