Healthcare Provider Details

I. General information

NPI: 1629295050
Provider Name (Legal Business Name): DAVID VERNON YOUNG D.D.S., M.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E 4500 S STE 202
SALT LAKE CITY UT
84107-2922
US

IV. Provider business mailing address

5102 COTTONWOOD LN
HOLLADAY UT
84117-7102
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-3578
  • Fax: 801-268-0444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number144139
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: