Healthcare Provider Details

I. General information

NPI: 1215112271
Provider Name (Legal Business Name): GEORGE B. YOUNG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 RTE. 94
BLAIRSTOWN NJ
07825
US

IV. Provider business mailing address

P.O. BOX 114 222 RTE. 94
BLAIRSTOWN NJ
07825
US

V. Phone/Fax

Practice location:
  • Phone: 908-362-8274
  • Fax:
Mailing address:
  • Phone: 908-362-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9383
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: