Provider Demographics
NPI:1508199829
Name:YOUNT, GREGORY GEORGE (DMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:GEORGE
Last Name:YOUNT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1217
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-1217
Mailing Address - Country:US
Mailing Address - Phone:217-235-0434
Mailing Address - Fax:217-234-3418
Practice Address - Street 1:225 RICHMOND AVE E
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4651
Practice Address - Country:US
Practice Address - Phone:217-235-0435
Practice Address - Fax:217-234-3418
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0209181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice