Healthcare Provider Details

I. General information

NPI: 1356715320
Provider Name (Legal Business Name): CYNTHIA YOUNG D.D.S., DENTAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SANTA RITA RD STE A
PLEASANTON CA
94566-5666
US

IV. Provider business mailing address

1400 SANTA RITA RD STE A
PLEASANTON CA
94566-5666
US

V. Phone/Fax

Practice location:
  • Phone: 925-398-3236
  • Fax:
Mailing address:
  • Phone: 925-398-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63578
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number63578
License Number StateCA

VIII. Authorized Official

Name: DR. CYNTHIA YOUNG
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 916-934-4712