Provider Demographics
NPI:1184777153
Name:YOUNG, ELDON D (DDS)
Entity type:Individual
Prefix:DR
First Name:ELDON
Middle Name:D
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 1:2022 JUDAH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1531
Mailing Address - Country:US
Mailing Address - Phone:415-681-6900
Mailing Address - Fax:415-681-6985
Practice Address - Street 1:2022 JUDAH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1531
Practice Address - Country:US
Practice Address - Phone:415-681-6900
Practice Address - Fax:415-681-6985
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice