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General NPI Number Information
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NPI Number | 1184712366
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Entity Type | Individual
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Provider Name | COREY ANDREW YOUNG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 1245 ST RT 598 SUITE B
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City | GALION
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State | OH
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Zip | 44833-1611
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Country | US
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Telephone | 419-468-2977
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Fax | 419-468-0037
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Provider Business Mailing Address
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Address Line | 1660 PARCHER RD
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City | BUCYRUS
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State | OH
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Zip | 44820-9570
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Country | US
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Telephone | 419-562-5019
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Fax | 419-468-0037
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.020599
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License Number State | OH
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