Healthcare Provider Details

I. General information

NPI: 1669618195
Provider Name (Legal Business Name): KATHRYN A YOUNG LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 MAIN ST
DAMARISCOTTA ME
04543-4683
US

IV. Provider business mailing address

40 HARRINGTON RD
WALPOLE ME
04573-3208
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-3368
  • Fax: 866-336-7756
Mailing address:
  • Phone: 207-563-3368
  • Fax: 866-336-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number5057
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: