Provider Demographics
NPI:1073650263
Name:YOUNG, JAMES ERNEST JR (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ERNEST
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2191
Mailing Address - Country:US
Mailing Address - Phone:864-229-1715
Mailing Address - Fax:864-229-0712
Practice Address - Street 1:355 W CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2191
Practice Address - Country:US
Practice Address - Phone:864-229-1715
Practice Address - Fax:864-229-0712
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice