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General NPI Number Information
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NPI Number | 1679602825
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Entity Type | Individual
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Provider Name | PHILIP EUGENE YOUNG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4919 DOUGLAS AVE SUITE 10
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City | DES MOINES
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State | IA
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Zip | 50310-2775
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Country | US
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Telephone | 515-278-2010
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Fax | 515-278-1944
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Provider Business Mailing Address
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Address Line | 4919 DOUGLAS AVE SUITE 10
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City | DES MOINES
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State | IA
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Zip | 50310-2775
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Country | US
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Telephone | 515-278-2010
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Fax | 515-278-1944
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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 | 6467
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License Number State | IA
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