MEDICARE: PEMA YOUDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D14982	MN

General Provider Information

NPI Number	:	1649950130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEMA YOUDON

Provider Business Mailing Address
First Line	:	1019 43RD AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3028
Country	:	US
Telephone Number	:	763-300-2848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 43RD AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3028
Country	:	US
Telephone Number	:	763-300-2848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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Directions to “ PEMA YOUDON ” Practice Location

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