Provider Demographics
NPI:1518581180
Name:YOUNG, SHAWN (DMD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
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 1:1425 PHILLIP MURRAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:OSHAWA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L1J 8L4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 PHILLIP MURRAY AVENUE
Practice Address - Street 2:
Practice Address - City:OSHAWA
Practice Address - State:ON
Practice Address - Zip Code:L1J8L4
Practice Address - Country:CA
Practice Address - Phone:647-533-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN182051223P0300X
MA182051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics