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General NPI Number Information
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NPI Number | 1598287161
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Entity Type | Organization
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Legal Business Name | YOUNG SMILES,LLC
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 324 HOLLY LANE
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City | LONDON
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State | KY
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Zip | 40741
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Country | US
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Telephone | 606-231-6536
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Fax |
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Provider Business Mailing Address
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Address Line | 324 HOLLY LN
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City | LONDON
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State | KY
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Zip | 40741-9726
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Country | US
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Telephone | 606-231-6536
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | JAMIE YOUNG
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Credential | RDH
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Telephone | 606-231-6536
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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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