Healthcare Provider Details

I. General information

NPI: 1790070910
Provider Name (Legal Business Name): SCOTT ANDREW YOUNG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31401 PACIFIC HWY S
FEDERAL WAY WA
98003-5403
US

IV. Provider business mailing address

31401 PACIFIC HWY S
FEDERAL WAY WA
98003-5403
US

V. Phone/Fax

Practice location:
  • Phone: 253-839-1007
  • Fax: 253-839-4035
Mailing address:
  • Phone: 253-839-1007
  • Fax: 253-839-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60438408
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12011668A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: