Provider Demographics
NPI:1215040191
Name:KAY L. YOUNGGREN, DDS
Entity Type:Organization
Organization Name:KAY L. YOUNGGREN, DDS
Other - Org Name:SMILE XPRESSIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNGGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-746-1900
Mailing Address - Street 1:601 S ROSELAWN AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2407
Mailing Address - Country:US
Mailing Address - Phone:575-746-1900
Mailing Address - Fax:575-748-2085
Practice Address - Street 1:601 S ROSELAWN AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2407
Practice Address - Country:US
Practice Address - Phone:575-746-1900
Practice Address - Fax:575-748-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty