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General NPI Number Information
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NPI Number | 1972170066
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Entity Type | Individual
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Provider Name | JACOB OVERTON YOUNG DDS
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Gender | Male
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 5540 SUNSET BLVD
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City | LEXINGTON
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State | SC
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Zip | 29072-9262
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Country | US
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Telephone | 803-358-8250
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Fax |
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Provider Business Mailing Address
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Address Line | 111 BRICKWORKS DR APT 1209
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City | CAYCE
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State | SC
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Zip | 29033-4432
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Country | US
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Telephone | 417-429-7777
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9906
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License Number State | SC
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