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General NPI Number Information
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NPI Number | 1891864682
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Entity Type | Organization
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Legal Business Name | BRIAN JACOBSON, DDS AND ALLYN YOUNG, DDS, PC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 31550 SCHOOLCRAFT RD
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City | LIVONIA
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State | MI
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Zip | 48150-1805
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Country | US
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Telephone | 734-522-6770
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Fax | 734-522-4062
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Provider Business Mailing Address
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Address Line | 31550 SCHOOLCRAFT RD
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City | LIVONIA
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State | MI
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Zip | 48150-1805
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Country | US
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Telephone | 734-522-6770
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Fax | 734-522-4062
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALLYN C YOUNG
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Credential | DDS
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Telephone | 734-522-6770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 013163
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 014485
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License Number State | MI
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