Provider Demographics
NPI:1235495920
Name:YOUNG, SHERRI LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:LYNN
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 1:130 MARVIN RD SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-456-7070
Mailing Address - Fax:360-456-2892
Practice Address - Street 1:130 MARVIN RD SE
Practice Address - Street 2:SUITE 201
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-456-7070
Practice Address - Fax:360-456-2892
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist