Healthcare Provider Details

I. General information

NPI: 1114234010
Provider Name (Legal Business Name): WILLIAM BRUCE YOUNG DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PELHAM RD S STE A
JACKSONVILLE AL
36265-2775
US

IV. Provider business mailing address

505 PELHAM RD S STE A
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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3308
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4566
License Number StateAL

VIII. Authorized Official

Name: DR. WILLIAM BRUCE YOUNG
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 256-435-4464