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General NPI Number Information
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NPI Number | 1124274014
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Entity Type | Organization
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Legal Business Name | YOUNG DENTISTRY FOR CHILDREN, LLC
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 1056 S 88TH ST
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City | LOUISVILLE
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State | CO
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Zip | 80027-9460
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Country | US
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Telephone | 303-604-0710
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Fax | 303-604-2995
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Provider Business Mailing Address
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Address Line | 1056 S 88TH ST
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City | LOUISVILLE
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State | CO
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Zip | 80027-9460
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Country | US
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Telephone | 303-604-0710
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Fax | 303-604-2995
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY O. YOUNG
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Credential | DDS
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Telephone | 303-280-9036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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