| Provider / Organization | NPI | Date Certified |
|---|---|---|
| RANDALL SCOTT DE YOUNG | 1104493410 | 2022-10-07 |
Randall Scott De Young is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1104493410. Registration indicates Randall Scott De Young is a provider of access to dentists-general services with a specialization in Dental Providers, Dentist (Dental Providers, Dentist) (Dentist, ) (Dental, ) (Dentist, Dental Providers) Access to Dentists-General (Dental Providers, Dentist) (Dental Providers, Dentist) (Dentist, ) (Dental, ) (Dentist, Dental Providers)
| Entity Type | Individual |
| Provider Name | Dr. Randall Scott De Young DDS |
| Practice Office Address | 1869 PORTER ST SW WYOMING, MI US |
| Practice Office Telephone | 6165327601 |
| Mailing Address | 2709 144TH AVE DORR, MI 493239707 US |
| Business Telephone | 6168213851 |
| Code | Practice | License No State |
|---|---|---|
| 122300000X | Access to Dentists-General Dental Providers Dentist Dental Providers Dentist Dentist Dental Dentist Dental Providers | RES.004364
OH |
| 122300000X PRIMARY | Access to Dentists-General Dental Providers Dentist Dental Providers Dentist Dentist Dental Dentist Dental Providers | 2901600996
MI |