Provider Demographics
NPI:1275105025
Name:OWYOUNG, ALEXANDER ALBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:ALBERT
Last Name:OWYOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RIVER GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4444
Mailing Address - Country:US
Mailing Address - Phone:916-955-8864
Mailing Address - Fax:
Practice Address - Street 1:1108 CORPORATE WAY STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-6119
Practice Address - Country:US
Practice Address - Phone:916-424-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist