Individual
NICOLE YOUNGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1705 BROADWAY AVE S, ROCHESTER, MN 55904
(507) 288-0120
Mailing address
3896 CAMEO PL NE, ROCHESTER, MN 55906-5459
(515) 954-9206
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D9120
OR
1223G0001X
General Practice Dentistry
Primary
D14051
MN
390200000X
Student in an Organized Health Care Education/Training Program
08796
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023504
—
OR
Enumeration date
07/23/2008
Last updated
02/10/2021
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