Provider Demographics
NPI:1558808964
Name:MICHAEL J. YOUNG, DDS, INC.
Entity Type:Organization
Organization Name:MICHAEL J. YOUNG, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-795-8814
Mailing Address - Street 1:24883 ORO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8232
Mailing Address - Country:US
Mailing Address - Phone:310-795-8814
Mailing Address - Fax:
Practice Address - Street 1:24400 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631-9334
Practice Address - Country:US
Practice Address - Phone:530-367-2250
Practice Address - Fax:530-367-4735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty