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General NPI Number Information
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NPI Number | 1104227883
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Entity Type | Organization
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Legal Business Name | YOUNG SMILES CHILDREN'S DENTISTRY LLC
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 114 MINNIE ST SUITE A
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City | FAIRBANKS
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State | AK
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Zip | 99701-3000
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Country | US
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Telephone | 907-452-4509
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Fax |
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Provider Business Mailing Address
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Address Line | 114 MINNIE ST SUITE A
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City | FAIRBANKS
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State | AK
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Zip | 99701-3000
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Country | US
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Telephone | 907-452-4509
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DALLIN YOUNG
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Credential |
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Telephone | 208-404-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN D1576
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License Number State | AK
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