Provider Demographics
NPI:1447347869
Name:RUTHERFORD YOUNGBAUER, MARY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LYNN
Last Name:RUTHERFORD YOUNGBAUER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MT
Mailing Address - Zip Code:59327-0068
Mailing Address - Country:US
Mailing Address - Phone:406-346-2131
Mailing Address - Fax:406-346-2133
Practice Address - Street 1:1617 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327-0068
Practice Address - Country:US
Practice Address - Phone:406-346-2131
Practice Address - Fax:406-346-2133
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT15384OtherBLUE CROSS
MT5511779OtherSTATE OF MT
MT0138008Medicaid
MN8331OtherSTATE BOARD MN