Provider Demographics
NPI:1306178967
Name:MARK J. YOUNG, DDS, MMSC, INC.
Entity Type:Organization
Organization Name:MARK J. YOUNG, DDS, MMSC, INC.
Other - Org Name:CREEKSIDE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-983-7700
Mailing Address - Street 1:1665 CREEKSIDE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3538
Mailing Address - Country:US
Mailing Address - Phone:916-983-7700
Mailing Address - Fax:916-983-7981
Practice Address - Street 1:1665 CREEKSIDE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3538
Practice Address - Country:US
Practice Address - Phone:916-983-7700
Practice Address - Fax:916-983-7981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty