Provider Demographics
NPI:1437488665
Name:YOUNG, DERRICK R (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5108 BELLEMEADE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4134
Mailing Address - Country:US
Mailing Address - Phone:812-477-9294
Mailing Address - Fax:812-402-1889
Practice Address - Street 1:5108 BELLEMEADE AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4134
Practice Address - Country:US
Practice Address - Phone:812-477-9294
Practice Address - Fax:812-402-1889
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011014A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics