Provider Demographics
NPI:1578538088
Name:YOUNG, STEVEN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:H
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 ATWOOD AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-4839
Mailing Address - Country:US
Mailing Address - Phone:401-273-7802
Mailing Address - Fax:401-272-9642
Practice Address - Street 1:1414 ATWOOD AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4839
Practice Address - Country:US
Practice Address - Phone:401-273-7802
Practice Address - Fax:401-272-9642
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-18
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT91481223S0112X
RI28581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U96944Medicare UPIN
CT190000942Medicare ID - Type Unspecified
RI199004278Medicare ID - Type Unspecified