Healthcare Provider Details

I. General information

NPI: 1356346282
Provider Name (Legal Business Name): CHRISTOPHER L. YOUNG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W MAIN ST
CUBA NY
14727-1317
US

IV. Provider business mailing address

140 W MAIN ST
CUBA NY
14727-1317
US

V. Phone/Fax

Practice location:
  • Phone: 585-968-2000
  • Fax: 585-968-3898
Mailing address:
  • Phone: 585-968-2000
  • Fax: 585-968-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number034838
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: