Provider Demographics
NPI:1679153563
Name:YOUNG, SCARLETT CLARICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCARLETT
Middle Name:CLARICE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2346
Mailing Address - Country:US
Mailing Address - Phone:715-853-2427
Mailing Address - Fax:
Practice Address - Street 1:657 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-1216
Practice Address - Country:US
Practice Address - Phone:715-524-2581
Practice Address - Fax:715-524-6271
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002595-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist