Healthcare Provider Details

I. General information

NPI: 1821098567
Provider Name (Legal Business Name): BRUCE MILTON YOUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 N 8TH ST SUITE 101
GRAND JUNCTION CO
81501-8845
US

IV. Provider business mailing address

2525 N 8TH ST SUITE 101
GRAND JUNCTION CO
81501-8845
US

V. Phone/Fax

Practice location:
  • Phone: 970-255-8024
  • Fax: 970-255-8025
Mailing address:
  • Phone: 970-255-8024
  • Fax: 970-255-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberH-D-1-04760
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: