Provider Demographics
NPI:1225015126
Name:YOUNG, SUSAN E (DDS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-656-3486
Mailing Address - Fax:724-598-7337
Practice Address - Street 1:2807 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1263
Practice Address - Country:US
Practice Address - Phone:724-656-3486
Practice Address - Fax:724-598-7337
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000006900122300000X
PADS036634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014835950004Medicaid
PA1014835950003Medicaid
OH2609449Medicaid
PA1014835950001Medicaid
PA1014835950005Medicaid
PA1014835950006Medicaid