Provider Demographics
NPI:1285070938
Name:YEN, PHILIP M (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:YEN
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 1:8301 E PRENTICE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2990
Mailing Address - Country:US
Mailing Address - Phone:720-606-4220
Mailing Address - Fax:720-606-4221
Practice Address - Street 1:8301 E PRENTICE AVE STE 215
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2990
Practice Address - Country:US
Practice Address - Phone:720-606-4220
Practice Address - Fax:720-606-4221
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604161223D0004X
CODEN.002018631223D0004X
CO002018631223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43552331Medicaid