Healthcare Provider Details

I. General information

NPI: 1811169733
Provider Name (Legal Business Name): DEAN YOUNCE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
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 NumberD3178OS
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: