Provider Demographics
NPI:1467679167
Name:NA, ANNE YOUNGSUE (DMD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:YOUNGSUE
Last Name:NA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 SUGARSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5029
Mailing Address - Country:US
Mailing Address - Phone:770-237-0220
Mailing Address - Fax:770-237-8007
Practice Address - Street 1:6139 OAKBROOK PKWY STE B
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1705
Practice Address - Country:US
Practice Address - Phone:770-448-7037
Practice Address - Fax:770-263-8803
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA10984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist