Provider Demographics
NPI:1487011664
Name:YOUNG, BRENT EVANS (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:EVANS
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 MANHATTAN BEACH BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5131
Mailing Address - Country:US
Mailing Address - Phone:310-545-4509
Mailing Address - Fax:
Practice Address - Street 1:973 MANHATTAN BEACH BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5131
Practice Address - Country:US
Practice Address - Phone:310-545-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice