Provider Demographics
NPI:1124256417
Name:YOUNG, EVAN GRAHAM (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:GRAHAM
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 1:2000 ABBOTT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3878
Mailing Address - Country:US
Mailing Address - Phone:907-349-5585
Mailing Address - Fax:
Practice Address - Street 1:2000 ABBOTT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3878
Practice Address - Country:US
Practice Address - Phone:907-349-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice