Dr. Randall Scott De Young, DDS
Dentist in Wyoming, MI. Individual provider (NPI-1).
NPI number1104493410
StatusActive
Last updated in NPPESOct 7, 2022
Details
- NPI
- 1104493410
- Entity type
- Individual (NPI-1)
- Name
- Dr. Randall Scott De Young
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 6, 2021
- Certification date
- Oct 7, 2022
- Last updated
- Oct 7, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 2901600996 | MI | Yes |
| 122300000X | Dentist | RES.004364 | OH |
Practice location
1869 Porter St SwWyoming, MI 49519-1709
Phone 616-532-7601
Mailing address
2709 144th AveDorr, MI 49323-9707
Phone 616-821-3851
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