Provider Demographics
NPI:1932193869
Name:YOUNG, DALLIN C (DDS)
Entity type:Individual
Prefix:
First Name:DALLIN
Middle Name:C
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:PO BOX 5881
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-5881
Mailing Address - Country:US
Mailing Address - Phone:208-733-9331
Mailing Address - Fax:208-732-1222
Practice Address - Street 1:1186 EASTLAND DR N
Practice Address - Street 2:SUITE B
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8973
Practice Address - Country:US
Practice Address - Phone:208-733-9331
Practice Address - Fax:208-732-1222
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-3874-PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6N474OtherBLUE CROSS PROVIDER ID
ID000010151637OtherBLUE SHIELD PROVIDER ID
ID807215900Medicaid
ID000010151637OtherBLUE SHIELD PROVIDER ID