Healthcare Provider Details

I. General information

NPI: 1457378382
Provider Name (Legal Business Name): DEAN C. YOUNCE, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5266 N EAGLE RD
BOISE ID
83713-0945
US

IV. Provider business mailing address

5266 N EAGLE RD
BOISE ID
83713-0945
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-4242
  • Fax:
Mailing address:
  • Phone: 208-939-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD-3178-OS
License Number StateID

VIII. Authorized Official

Name: DR. DEAN CHARLES YOUNCE
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 208-939-4242