Provider Demographics
NPI:1083737084
Name:NONA, YOUNAN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOUNAN
Middle Name:P
Last Name:NONA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38800 RYAN RD
Mailing Address - Street 2:SUITE #106
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2993
Mailing Address - Country:US
Mailing Address - Phone:586-795-9100
Mailing Address - Fax:586-795-9110
Practice Address - Street 1:38800 RYAN RD
Practice Address - Street 2:SUITE #106
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2993
Practice Address - Country:US
Practice Address - Phone:586-795-9100
Practice Address - Fax:586-795-9110
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010169791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4414051Medicaid