Healthcare Provider Details

I. General information

NPI: 1952479230
Provider Name (Legal Business Name): STEVEN RYAN YOUNG DMD, CAGS, PLLC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S VAL VISTA DR STE 101
MESA AZ
85204-7304
US

IV. Provider business mailing address

1702 S VAL VISTA DR STE 101
MESA AZ
85204-7304
US

V. Phone/Fax

Practice location:
  • Phone: 480-668-8200
  • Fax: 480-668-8202
Mailing address:
  • Phone: 480-668-8200
  • Fax: 480-668-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6968
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: