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General NPI Number Information
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NPI Number | 1306317755
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Entity Type | Organization
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Legal Business Name | KIMMER E. YOUNG D.D.S. DENTAL CORPORATION
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 12/13/2018
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Provider Practice Location Address
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Address Line | 2401 W CLEVELAND AVE
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City | MADERA
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State | CA
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Zip | 93637-3608
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Country | US
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Telephone | 559-673-4075
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 W CLEVELAND AVE
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City | MADERA
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State | CA
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Zip | 93637-3608
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Country | US
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Telephone | 559-970-6188
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMMER E YOUNG
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Credential |
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Telephone | 559-673-4075
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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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