Provider Demographics
NPI:1114210531
Name:LORETTE M. POLITE-YOUNG DDS PA
Entity Type:Organization
Organization Name:LORETTE M. POLITE-YOUNG DDS PA
Other - Org Name:YOUNG & POLITE CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLITE-YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-548-8377
Mailing Address - Street 1:2514 CUTHBERTSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6416
Mailing Address - Country:US
Mailing Address - Phone:704-243-5898
Mailing Address - Fax:704-843-4516
Practice Address - Street 1:2514 CUTHBERTSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6416
Practice Address - Country:US
Practice Address - Phone:704-243-5898
Practice Address - Fax:704-843-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty