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General NPI Number Information
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NPI Number | 1891174926
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Entity Type | Organization
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Legal Business Name | JULI YOUNG, DMD, PC
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Dates
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Enumeration Date | 05/21/2015
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 6993 REDANSA DR
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City | ROCKFORD
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State | IL
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Zip | 61108-1201
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Country | US
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Telephone | 815-397-3661
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Fax |
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Provider Business Mailing Address
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Address Line | 6993 REDANSA DR
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City | ROCKFORD
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State | IL
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Zip | 61108-1201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JULI YOUNG
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Credential | DMD
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Telephone | 815-397-3661
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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 | 019027494
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License Number State | IL
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