Provider Demographics
NPI:1194809848
Name:YU, HENRY C (DMD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:C
Last Name:YU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 W OLIVE AVE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3147
Mailing Address - Country:US
Mailing Address - Phone:623-334-8300
Mailing Address - Fax:623-334-8200
Practice Address - Street 1:5700 W OLIVE AVE
Practice Address - Street 2:SUITE #105
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3147
Practice Address - Country:US
Practice Address - Phone:623-334-8300
Practice Address - Fax:623-334-8200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6345122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1827073OtherUNITED CONCORDIA ID