Provider Demographics
NPI:1063710655
Name:DEYOUNG, ERIK DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:DANIEL
Last Name:DEYOUNG
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 1:6100 W STATE ST
Mailing Address - Street 2:APT. 636
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2983
Mailing Address - Country:US
Mailing Address - Phone:404-819-1282
Mailing Address - Fax:
Practice Address - Street 1:6100 W STATE ST
Practice Address - Street 2:APT. 636
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2983
Practice Address - Country:US
Practice Address - Phone:404-819-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6633-0151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics