Ellery Grace Young, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE60877908 Issued in WA

Practice address

1502 N Vercler Rd
Spokane Valley, WA 99216

Phone

(509) 444-8200

Fax

(509) 444-7806

NPI assigned

Oct 12, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• CD Camas SE (Dba Comfort Dental Camas)

  • Dental Clinic/Center
  • Camas, WA
  • NPI 1275052359
  NPD (past)

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

{
    "created_epoch": "1539302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548806400000",
    "number": "1124593405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 N WASHINGTON ST STE 300",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992010254",
            "telephone_number": "509-444-8888",
            "fax_number": "509-444-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 N VERCLER RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "99216",
            "telephone_number": "509-444-8200",
            "fax_number": "509-444-7806"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2004 SE 192nd Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986839505",
            "country_code": "US",
            "telephone_number": "360-768-5609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "ELLERY",
        "middle_name": "GRACE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-12",
        "last_updated": "2019-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60877908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "1275052359",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexander Lawrence Young, MSW
• Allison Murray Young, MD
• Cody G Young
• Deanna Lynn Young, PTA
• Diamond Young
• Gina Young
• Grace Marie Young
• Jaylah Young
• Megan Marie Young, MSW
• Michael James Young, PTA

• Dentist in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.