Provider Demographics
NPI:1497929228
Name:YOUNKINS, GLENN D (DDS)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:D
Last Name:YOUNKINS
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 1:205 E BEAVER AVE
Mailing Address - Street 2:GLENNLAND BUILDING
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4903
Mailing Address - Country:US
Mailing Address - Phone:814-238-5252
Mailing Address - Fax:814-238-5756
Practice Address - Street 1:205 E BEAVER AVE
Practice Address - Street 2:GLENNLAND BUILDING
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4903
Practice Address - Country:US
Practice Address - Phone:814-238-5252
Practice Address - Fax:814-238-5756
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030985L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice