Provider Demographics
NPI:1679602825
Name:YOUNG, PHILIP EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EUGENE
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 1:4919 DOUGLAS AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-2775
Mailing Address - Country:US
Mailing Address - Phone:515-278-2010
Mailing Address - Fax:515-278-1944
Practice Address - Street 1:4919 DOUGLAS AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2775
Practice Address - Country:US
Practice Address - Phone:515-278-2010
Practice Address - Fax:515-278-1944
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0223354Medicaid