Provider Demographics
NPI:1578642807
Name:YOUNG, BRADFORD GREGORY (DMD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:GREGORY
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 1:1275 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6207
Mailing Address - Country:US
Mailing Address - Phone:106-439-1363
Mailing Address - Fax:610-439-1892
Practice Address - Street 1:1275 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-439-1363
Practice Address - Fax:610-439-1892
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist