Provider Demographics
NPI:1467484097
Name:YOUNG, KERA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KERA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
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:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-0486
Mailing Address - Country:US
Mailing Address - Phone:813-829-9075
Mailing Address - Fax:813-829-9075
Practice Address - Street 1:13131 KINGS LAKE DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:GIBSONTON
Practice Address - State:FL
Practice Address - Zip Code:33534
Practice Address - Country:US
Practice Address - Phone:813-829-9075
Practice Address - Fax:813-829-9075
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBY 6499823OtherDEA