Healthcare Provider Details

I. General information

NPI: 1053807776
Provider Name (Legal Business Name): RONALD L YOUNG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2715
US

IV. Provider business mailing address

810 EUTERPE ST APT 9403
NEW ORLEANS LA
70130-8628
US

V. Phone/Fax

Practice location:
  • Phone: 504-619-8572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS-978
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: