Provider Demographics
NPI:1518098060
Name:TSO AND YOUNG PC
Entity Type:Organization
Organization Name:TSO AND YOUNG PC
Other - Org Name:LAKE MARTIN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:TSO
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-234-6011
Mailing Address - Street 1:659 ALEX CITY SHOPPING CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010
Mailing Address - Country:US
Mailing Address - Phone:256-234-6011
Mailing Address - Fax:256-234-6703
Practice Address - Street 1:659 ALEX CITY SHOPPING CENTER DR
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010
Practice Address - Country:US
Practice Address - Phone:256-234-6011
Practice Address - Fax:256-234-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty