Healthcare Provider Details

I. General information

NPI: 1831362656
Provider Name (Legal Business Name): SEAN YOUNG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2008
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 STANSBERRY LN SUITE 101
FRANKLIN TN
37069-5125
US

IV. Provider business mailing address

200 LONG VALLEY RD
BRENTWOOD TN
37027-4945
US

V. Phone/Fax

Practice location:
  • Phone: 615-591-0919
  • Fax:
Mailing address:
  • Phone: 615-500-2809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9062
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: