Healthcare Provider Details

I. General information

NPI: 1457038739
Provider Name (Legal Business Name): KATE DURHAM YOUNG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE ELIZABETH DURHAM

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVENUE WOMACK ARMY MEDICAL CENTER
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

2817 ROCK MERRITT AVENUE WOMACK ARMY MEDICAL CENTER
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8922
  • Fax: 910-907-6069
Mailing address:
  • Phone: 910-907-8922
  • Fax: 910-907-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10933
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number10933
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10933
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: