Provider Demographics
NPI:1396028338
Name:YOUNG, SIMON (DDS, MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS, MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 M D ANDERSON BLVD STE 2.059
Mailing Address - Street 2:UNIVERSITY OF TEXAS HOUSTON DENTAL SCHOOL
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3402
Mailing Address - Country:US
Mailing Address - Phone:713-500-4125
Mailing Address - Fax:
Practice Address - Street 1:6516 M D ANDERSON BLVD STE 2.059
Practice Address - Street 2:UNIVERSITY OF TEXAS HOUSTON DENTAL SCHOOL
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3402
Practice Address - Country:US
Practice Address - Phone:713-500-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist