Healthcare Provider Details

I. General information

NPI: 1841546736
Provider Name (Legal Business Name): AUBREY YOUNG D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17235 N 75TH AVE STE A100
GLENDALE AZ
85308-0884
US

IV. Provider business mailing address

17235 N 75TH AVE STE A100
GLENDALE AZ
85308-0884
US

V. Phone/Fax

Practice location:
  • Phone: 623-825-6901
  • Fax: 623-825-9446
Mailing address:
  • Phone: 623-825-6901
  • Fax: 623-825-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9132
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6297
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: