Provider Demographics
NPI:1124254248
Name:YOUNGNER, ERIC PHILIP (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PHILIP
Last Name:YOUNGNER
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 1:11800 ABERDEEN ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4808
Mailing Address - Country:US
Mailing Address - Phone:763-639-7196
Mailing Address - Fax:
Practice Address - Street 1:800 CALIFORNIA AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-3456
Practice Address - Country:US
Practice Address - Phone:763-639-7196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist