NPIMap

Organization Active NPI

De Young Dental Associates, PLLC

  • Dental Clinic/Center
  • Wyoming, MI
National Provider Identifier
1720704729
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
DE YOUNG DENTAL ASSOCIATES, PLLC
Practice address
1869 Porter St SW
Wyoming, MI 49519-1709
Phone
(616) 532-7601
NPI assigned
Oct 12, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

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

Authorized official

Name
Dr. Randall Scott De Young, DDSNPI 1104493410
Title
Ceo
Phone
(616) 821-3851

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1869 Porter St SW
Wyoming, MI 49519-1709

Mailing address

1869 Porter St SW
Wyoming, MI 49519-1709

National Provider Directory

National Provider Directory

Locations

1869 Porter St SW
Wyoming, MI 49519
Phone (616) 532-7601

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1720704729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1869 PORTER ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495191709"
        },
        {
            "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": {
        "organization_name": "DE YOUNG DENTAL ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "DE YOUNG",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "616-821-3851",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 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.