Provider Demographics
NPI:1477757276
Name:YOUNG, TIMOTHY GATES (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GATES
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 N ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1806
Mailing Address - Country:US
Mailing Address - Phone:419-586-1661
Mailing Address - Fax:419-584-0424
Practice Address - Street 1:136 N ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1806
Practice Address - Country:US
Practice Address - Phone:419-586-1661
Practice Address - Fax:419-584-0424
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-015811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist