Provider Demographics
NPI:1659819605
Name:GOODMAN YOUNG PLLC
Entity Type:Organization
Organization Name:GOODMAN YOUNG PLLC
Other - Org Name:TIMBERLINE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ORVAL
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-646-3940
Mailing Address - Street 1:PO BOX 1169
Mailing Address - Street 2:796 E. KIOWA AVE. SUITE H12
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107
Mailing Address - Country:US
Mailing Address - Phone:303-646-3940
Mailing Address - Fax:
Practice Address - Street 1:796 E. KIOWA AVE.
Practice Address - Street 2:SUITE H12
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107
Practice Address - Country:US
Practice Address - Phone:303-646-3940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty