Provider Demographics
NPI:1346454451
Name:YOUNG, LARRY C (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:C
Last Name:YOUNG
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 1:4487 BAYMEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4716
Mailing Address - Country:US
Mailing Address - Phone:904-731-9833
Mailing Address - Fax:904-731-2334
Practice Address - Street 1:4487 BAYMEADOWS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4716
Practice Address - Country:US
Practice Address - Phone:904-731-9833
Practice Address - Fax:904-731-2334
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN61911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice