Provider Demographics
NPI:1356442610
Name:YOUNG, JOHN JOSEPH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30 E 40TH ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1201
Mailing Address - Country:US
Mailing Address - Phone:212-684-6520
Mailing Address - Fax:212-684-6479
Practice Address - Street 1:30 E 40TH ST
Practice Address - Street 2:SUITE 502
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1201
Practice Address - Country:US
Practice Address - Phone:212-684-6520
Practice Address - Fax:212-684-6479
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0406211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice