Provider Demographics
NPI:1275748097
Name:YOUNG, JUSTIN M (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:M
Last Name:YOUNG
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:1000 JOHNSON FERRY RD
Mailing Address - Street 2:BLDG H
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2114
Mailing Address - Country:US
Mailing Address - Phone:770-977-0364
Mailing Address - Fax:678-483-8487
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:BLDG H
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2114
Practice Address - Country:US
Practice Address - Phone:770-977-0364
Practice Address - Fax:678-483-8487
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2013-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADS035364122300000X, 1223S0112X
NMMD 20008-08002082S0099X
GA710761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck