Basic Information
| Provider Information | |||||||||
| NPI: | 1225273535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3115 HOWE PLACE STE 101 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606760642 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3115 HOWE PLACE STE 101 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606760642 | ||||||||
| FaxNumber: | 3304715947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2008 | ||||||||
| LastUpdateDate: | 12/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 30-022919 | OH | N | Dental Providers | Dentist | 122300000X | DE60091148 | WA | Y | Dental Providers | Dentist |
No ID Information.