Provider Demographics
NPI:1538323613
Name:AN, BENJAMIN YOUNG (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:YOUNG
Last Name:AN
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 1:442 SW UMATILLA AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7039
Mailing Address - Country:US
Mailing Address - Phone:541-504-3900
Mailing Address - Fax:
Practice Address - Street 1:9900 SW GREENBURG RD
Practice Address - Street 2:STE 240
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5502
Practice Address - Country:US
Practice Address - Phone:888-468-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60013040122300000X
ORD10061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist