Provider Demographics
NPI:1528733920
Name:YEO, MINSOO (DMD)
Entity type:Individual
Prefix:DR
First Name:MINSOO
Middle Name:
Last Name:YEO
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 1:700 W MAGNOLIA AVE APT X6
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-4539
Mailing Address - Country:US
Mailing Address - Phone:334-220-4441
Mailing Address - Fax:
Practice Address - Street 1:2015 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5415
Practice Address - Country:US
Practice Address - Phone:334-203-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1225241223G0001X
ALD-0006957-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice