Healthcare Provider Details

I. General information

NPI: 1184234460
Provider Name (Legal Business Name): NICOLAS K. YOUNG, D.M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W 800 N
OREM UT
84057-3728
US

IV. Provider business mailing address

440 W 800 N
OREM UT
84057-3728
US

V. Phone/Fax

Practice location:
  • Phone: 801-764-9444
  • Fax: 801-229-2633
Mailing address:
  • Phone: 801-764-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLAS KENT YOUNG
Title or Position: PRESIDENT
Credential: DMD
Phone: 801-310-4697