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General NPI Number Information
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NPI Number | 1467484097
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Entity Type | Individual
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Provider Name | KERA YOUNG DDS
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 13131 KINGS LAKE DRIVE SUITE 104
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City | GIBSONTON
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State | FL
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Zip | 33534
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Country | US
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Telephone | 813-829-9075
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Fax | 813-829-9075
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Provider Business Mailing Address
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Address Line | PO BOX 486
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City | LITHIA
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State | FL
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Zip | 33547-0486
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Country | US
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Telephone | 813-829-9075
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Fax | 813-829-9075
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN15193
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License Number State | FL
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