Provider Demographics
NPI:1679751234
Name:DEYOUNG, AMY P (DDS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:P
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13961 60TH ST N
Mailing Address - Street 2:PO BOX 291
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-1053
Mailing Address - Country:US
Mailing Address - Phone:651-439-2600
Mailing Address - Fax:
Practice Address - Street 1:13961 60TH ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-1053
Practice Address - Country:US
Practice Address - Phone:651-439-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist