Provider Demographics
NPI:1083751127
Name:ROBERT L. YOUNG, JR. , DDS
Entity Type:Organization
Organization Name:ROBERT L. YOUNG, JR. , DDS
Other - Org Name:YOUNG AND POLITE CHILDRENS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-587-7336
Mailing Address - Street 1:11010 S TRYON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273
Mailing Address - Country:US
Mailing Address - Phone:704-587-7336
Mailing Address - Fax:704-587-7579
Practice Address - Street 1:11010 S TRYON ST STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273
Practice Address - Country:US
Practice Address - Phone:704-587-7336
Practice Address - Fax:704-587-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78211223P0221X
NC77971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZN7821Medicaid
NC89902WMedicaid
SCZN7797Medicaid
NC5904100Medicaid