Provider Demographics
NPI:1619640380
Name:YOUNG, TAPHAPHENE (DMD)
Entity Type:Individual
Prefix:
First Name:TAPHAPHENE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3611
Mailing Address - Country:US
Mailing Address - Phone:413-319-1078
Mailing Address - Fax:
Practice Address - Street 1:217 SOUTH ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3611
Practice Address - Country:US
Practice Address - Phone:413-319-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL14882122300000X
MADN18598211223D0004X, 1223E0200X, 1223P0221X, 1223S0112X, 1223X0400X, 1223G0001X
MAFY10295061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223D0004XDental ProvidersDentistDentist Anesthesiologist
No1223E0200XDental ProvidersDentistEndodontics
No1223P0221XDental ProvidersDentistPediatric Dentistry
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics