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General NPI Number Information
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NPI Number | 1225524226
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Entity Type | Organization
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Legal Business Name | YOUNG DENTAL CORPORATION
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 1705 BRANHAM LN STE B4
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City | SAN JOSE
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State | CA
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Zip | 95118-5222
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Country | US
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Telephone | 408-264-7630
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 BRANHAM LN STE B4
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City | SAN JOSE
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State | CA
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Zip | 95118-5222
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Country | US
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Telephone | 805-270-9322
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW J YOUNG
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Credential |
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Telephone | 805-270-9322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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