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General NPI Number Information
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NPI Number | 1699303446
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Entity Type | Organization
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Legal Business Name | YOUNG GREENFIELD DENTAL PRACTICE LLC
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Dates
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Enumeration Date | 03/28/2020
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Last Update Date | 03/28/2020
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Provider Practice Location Address
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Address Line | 1798 MELODY LN
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City | GREENFIELD
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State | IN
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Zip | 46140-1191
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Country | US
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Telephone | 317-468-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 2850 E FAIRWAY VILLAGE DR
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City | GREENFIELD
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State | IN
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Zip | 46140-8160
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Country | US
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Telephone | 317-902-3185
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Fax | 765-932-5174
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDY C YOUNG
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Credential | DDS
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Telephone | 317-902-3185
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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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