Provider Demographics
NPI:1548460736
Name:YU, ANNIE S (DDS, FAGD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:S
Last Name:YU
Suffix:
Gender:F
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 WISCONSIN AVE STE 1035
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6918
Mailing Address - Country:US
Mailing Address - Phone:240-743-4421
Mailing Address - Fax:
Practice Address - Street 1:5454 WISCONSIN AVE STE 1035
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6918
Practice Address - Country:US
Practice Address - Phone:240-743-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2013-08-30
Deactivation Date:2007-09-25
Deactivation Code:
Reactivation Date:2013-08-22
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000631122300000X
MD14299122300000X
VA0401412020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist