1609810795 NPI number — DR. RICHARD B YOUNG D.D.S.

Table of content: DR. RICHARD B YOUNG D.D.S. (NPI 1609810795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609810795 NPI number — DR. RICHARD B YOUNG D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
RICHARD
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609810795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 HILLCREST AVE
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
OWATONNA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55060-3680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-451-0290
Provider Business Mailing Address Fax Number:
507-451-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 W OAKLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55912-2317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-433-1031
Provider Business Practice Location Address Fax Number:
507-433-6115
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  D10215 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0009975 . This is a "DORAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1008934 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 118100 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 46406YO . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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