Provider Demographics
NPI:1992258503
Name:YOUNG, JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
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 1:202 S 38TH ST
Mailing Address - Street 2:APT 308
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3251
Mailing Address - Country:US
Mailing Address - Phone:858-688-3140
Mailing Address - Fax:
Practice Address - Street 1:989375 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-9375
Practice Address - Country:US
Practice Address - Phone:402-559-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist