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General NPI Number Information
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NPI Number | 1124254248
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Entity Type | Individual
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Provider Name | ERIC PHILIP YOUNGNER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 800 CALIFORNIA AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55117-3456
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Country | US
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Telephone | 763-639-7196
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Fax |
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Provider Business Mailing Address
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Address Line | 11800 ABERDEEN ST NE
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City | BLAINE
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State | MN
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Zip | 55449-4808
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Country | US
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Telephone | 763-639-7196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D12645
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License Number State | MN
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