Individual
DALLIN C YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1186 EASTLAND DR N, SUITE B, TWIN FALLS, ID 83301-8973
(208) 733-9331
(208) 732-1222
Mailing address
PO BOX 5881, TWIN FALLS, ID 83303-5881
(208) 733-9331
(208) 732-1222
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D-3874-PD
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010151637
BLUE SHIELD PROVIDER ID
ID
01
—
6N474
BLUE CROSS PROVIDER ID
IL
05
—
807215900
—
ID
Enumeration date
09/07/2005
Last updated
07/09/2007
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