Basic Information
| Provider Information | |||||||||
| NPI: | 1346464179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 457 CORINTH CIRCLE | ||||||||
| Address2: | |||||||||
| City: | DUNDEE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48131 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 132 COLE RD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481624104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342427120 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 12/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 22140 | OH | N | Dental Providers | Dentist | 122300000X | 2901019226 | MI | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 2562098 | 05 | OH | MEDICAID |