Provider Demographics
NPI:1922291400
Name:YOUNG, DEIRDRE DANIELLE (DDS)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:DANIELLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16068 E 8 MILE RD
Mailing Address - Street 2:EASTLAND FAMILY DENTISTRY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1416
Mailing Address - Country:US
Mailing Address - Phone:313-372-8580
Mailing Address - Fax:313-372-7739
Practice Address - Street 1:16068 E 8 MILE RD
Practice Address - Street 2:EASTLAND FAMILY DENTISTRY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1416
Practice Address - Country:US
Practice Address - Phone:313-372-8580
Practice Address - Fax:313-372-7739
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019647122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist