Provider Demographics
NPI:1629185954
Name:YOUNG, MARK C (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1100 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903
Mailing Address - Country:US
Mailing Address - Phone:434-979-1365
Mailing Address - Fax:434-979-7880
Practice Address - Street 1:240 HYDRAULIC RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8130
Practice Address - Country:US
Practice Address - Phone:434-979-1365
Practice Address - Fax:434-979-7880
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007820674Medicaid