Provider Demographics
NPI:1164452132
Name:BRENTON L YOUNG DDS AND PAULINE E CAHILL DDS PA
Entity Type:Organization
Organization Name:BRENTON L YOUNG DDS AND PAULINE E CAHILL DDS PA
Other - Org Name:SHELBY DENTAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-482-7986
Mailing Address - Street 1:1429 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3406
Mailing Address - Country:US
Mailing Address - Phone:704-482-7986
Mailing Address - Fax:704-480-9301
Practice Address - Street 1:1429 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3406
Practice Address - Country:US
Practice Address - Phone:704-482-7986
Practice Address - Fax:704-480-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890298HMedicaid
NC0298HOtherBLUE CROSS BLUE SHIELD
NC0298HOtherBLUE CROSS BLUE SHIELD
NCT63943Medicare UPIN