Provider Demographics
NPI:1801828280
Name:YOUNG, DONALD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:906 NESS CORNER RD
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0268
Mailing Address - Country:US
Mailing Address - Phone:360-385-4373
Mailing Address - Fax:360-385-2252
Practice Address - Street 1:906 NESS CORNER RD
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339-9429
Practice Address - Country:US
Practice Address - Phone:360-385-4373
Practice Address - Fax:360-385-2252
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA63081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00635OtherWASHINGTON DENTAL SERVICE
HI504613OtherHAWAII DENTAL SERVICE
WA862087OtherUNITED CONCORDIA INS CO