Provider Demographics
NPI:1568794071
Name:YOUNG, EMILY RUTH (DMD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:RUTH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 NE LOCKWOOD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-2603
Mailing Address - Country:US
Mailing Address - Phone:503-290-9837
Mailing Address - Fax:
Practice Address - Street 1:6715 NE 63RD ST STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-1980
Practice Address - Country:US
Practice Address - Phone:360-699-5555
Practice Address - Fax:360-699-8999
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601044861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice