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General NPI Number Information
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NPI Number | 1265589022
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Entity Type | Organization
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Legal Business Name | YOUNG FAMILY DENTISTRY
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8470 NW EXPRESSWAY ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-6009
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Country | US
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Telephone | 405-728-8400
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Fax | 405-720-1777
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Provider Business Mailing Address
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Address Line | 8470 NW EXPRESSWAY ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-6009
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Country | US
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Telephone | 405-728-8400
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Fax | 405-720-1777
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Authorized Official
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Title or Position | OFFICE MANAGER DENTAL ASSISTANT
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Name | MRS. JEANNETTE AMANDA BROWN
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Credential |
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Telephone | 405-728-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5629
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License Number State | OK
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