Healthcare Provider Details

I. General information

NPI: 1780607010
Provider Name (Legal Business Name): WILLIAM BRUCE YOUNG D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PELHAM RD S
JACKSONVILLE AL
36265-2775
US

IV. Provider business mailing address

505 PELHAM RD S
JACKSONVILLE AL
36265-2775
US

V. Phone/Fax

Practice location:
  • Phone: 256-435-4464
  • Fax: 256-435-2079
Mailing address:
  • Phone: 256-435-4464
  • Fax: 256-435-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3308
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: