Randall Scott De Young, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901600996 Issued in MI

Practice address

1869 Porter St SW
Wyoming, MI 49519-1709

Phone

(616) 532-7601

NPI assigned

Jun 6, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• De Young Dental Associates, PLLC

  • Dental Clinic/Center
  • Wyoming, MI
  • NPI 1720704729
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1104493410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2709 144TH AVE",
            "city": "DORR",
            "state": "MI",
            "postal_code": "493239707",
            "telephone_number": "616-821-3851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1869 PORTER ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495191709",
            "telephone_number": "616-532-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE YOUNG",
        "first_name": "RANDALL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-06",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "RES.004364",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901600996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Camelia Davis
• David Davis Jr., MSW
• Shoshana Davis
• Nancy Louise De Nolf, NNP
• De Young Dental Associates, PLLC
• Miranda Grace Deal, RDN
• Kileya Deb0Arge
• Jamie Lynn Decker, MA, LLP
• Kevin F Dedoe, NP
• Cassandra Dedoes, LLPC

• Dentist in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.