Healthcare Provider Details

I. General information

NPI: 1164680245
Provider Name (Legal Business Name): CRAIG A. YOUNG, DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 N GLASSFORD HILL RD STE 102
PRESCOTT VALLEY AZ
86314-2256
US

IV. Provider business mailing address

2820 N GLASSFORD HILL RD STE 102
PRESCOTT VALLEY AZ
86314-2256
US

V. Phone/Fax

Practice location:
  • Phone: 928-775-8448
  • Fax:
Mailing address:
  • Phone: 928-775-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7399
License Number StateAZ

VIII. Authorized Official

Name: CRAIG A YOUNG
Title or Position: ORTHODONTIST
Credential: DMD
Phone: 928-775-8448