Provider Demographics
NPI:1558488841
Name:YOUNG, CHARLES F (DMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
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 1:604 BRUNSON DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4947
Mailing Address - Country:US
Mailing Address - Phone:662-844-0894
Mailing Address - Fax:662-844-5126
Practice Address - Street 1:604 BRUNSON DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4947
Practice Address - Country:US
Practice Address - Phone:662-844-0894
Practice Address - Fax:662-844-5126
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1903-801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice