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General NPI Number Information
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NPI Number | 1285189092
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Entity Type | Organization
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Legal Business Name | SAMUEL YOUNG DMD INC
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 31538 WHITEFIELD CT
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City | MURRIETA
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State | CA
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Zip | 92563-6216
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Country | US
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Telephone | 951-760-2481
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Fax |
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Provider Business Mailing Address
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Address Line | 31538 WHITEFIELD CT
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City | MURRIETA
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State | CA
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Zip | 92563-6216
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Country | US
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Telephone | 951-760-2481
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMUEL YOUNG
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Credential | DMD
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Telephone | 951-760-2481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 33695
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License Number State | CA
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