Provider Demographics
NPI:1497888564
Name:YOUNG, DIANA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 WESTGATE CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3043
Mailing Address - Country:US
Mailing Address - Phone:336-765-4688
Mailing Address - Fax:336-760-0667
Practice Address - Street 1:1341 WESTGATE CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3043
Practice Address - Country:US
Practice Address - Phone:336-765-4688
Practice Address - Fax:336-760-0667
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4680124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4680OtherNC HYGIENE LICENSE