Healthcare Provider Details

I. General information

NPI: 1093410367
Provider Name (Legal Business Name): MADELINE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 RIVER POINT PKWY UNIT A
ENGLEWOOD CO
80110-3315
US

IV. Provider business mailing address

3302 GASTON AVE
DALLAS TX
75246-2013
US

V. Phone/Fax

Practice location:
  • Phone: 130-378-1234
  • Fax:
Mailing address:
  • Phone: 214-828-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00206692
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: