Provider Demographics
NPI:1417029786
Name:YOUNG, THELMA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:THELMA
Other - Middle Name:AGONIAS
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3875 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 901
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010
Mailing Address - Country:US
Mailing Address - Phone:213-383-2700
Mailing Address - Fax:213-383-2937
Practice Address - Street 1:3875 WILSHIRE BLVD
Practice Address - Street 2:SUITE 901
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:213-383-2700
Practice Address - Fax:213-383-2937
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist