Provider Demographics
NPI:1609810795
Name:YOUNG, RICHARD B (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:YOUNG
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 1:605 HILLCREST AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3680
Mailing Address - Country:US
Mailing Address - Phone:507-451-0290
Mailing Address - Fax:507-451-0291
Practice Address - Street 1:605 W OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2317
Practice Address - Country:US
Practice Address - Phone:507-433-1031
Practice Address - Fax:507-433-6115
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND102151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0009975OtherDORAL
MN1008934OtherPREFERRED ONE
MN118100OtherUCARE
MN46406YOOtherBCBS
MN46406YOOtherBCBS