Provider Demographics
NPI:1790370161
Name:YOUNGER, ELANA SHIRA (DMD)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:SHIRA
Last Name:YOUNGER
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 1:1820 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2304
Mailing Address - Country:US
Mailing Address - Phone:937-332-8644
Mailing Address - Fax:
Practice Address - Street 1:1820 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2304
Practice Address - Country:US
Practice Address - Phone:937-332-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist