Provider Demographics
NPI:1730397720
Name:YOUNG, TONNIE L (DDS)
Entity type:Individual
Prefix:DR
First Name:TONNIE
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4408
Mailing Address - Country:US
Mailing Address - Phone:708-383-5115
Mailing Address - Fax:708-383-0436
Practice Address - Street 1:611 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4408
Practice Address - Country:US
Practice Address - Phone:708-383-5115
Practice Address - Fax:708-383-0436
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice