Provider Demographics
NPI:1619464732
Name:YOUNG, HESTON ALEXANDRE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HESTON
Middle Name:ALEXANDRE
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 1:12002 HELVICK CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-3284
Mailing Address - Country:US
Mailing Address - Phone:316-305-7105
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 310
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3004
Practice Address - Country:US
Practice Address - Phone:713-500-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice