Provider Demographics
NPI:1023097482
Name:YOUNGMAN, DWIGHT LAUGHTON (DDS)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:LAUGHTON
Last Name:YOUNGMAN
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:PO BOX 128
Mailing Address - Street 2:3305 MILLER STREET
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-0128
Mailing Address - Country:US
Mailing Address - Phone:660-425-3616
Mailing Address - Fax:
Practice Address - Street 1:3305 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2716
Practice Address - Country:US
Practice Address - Phone:660-425-3616
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOD0121211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice