Provider Demographics
NPI:1043837495
Name:YOUNG, NICOLETTE PAIGE (DMD)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:PAIGE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 WINDSOR RDG S
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1435
Mailing Address - Country:US
Mailing Address - Phone:757-585-8632
Mailing Address - Fax:
Practice Address - Street 1:3817 GRUBER RD
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-8925
Practice Address - Country:US
Practice Address - Phone:910-396-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist