Provider Demographics
NPI:1689761645
Name:YOUNG, JOHN D III (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:YOUNG
Suffix:III
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 1:2829 BABCOCK RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6028
Mailing Address - Country:US
Mailing Address - Phone:210-692-9556
Mailing Address - Fax:210-692-0909
Practice Address - Street 1:2829 BABCOCK RD
Practice Address - Street 2:SUITE 126
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6028
Practice Address - Country:US
Practice Address - Phone:210-692-9556
Practice Address - Fax:210-692-0909
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD129251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110902701Medicaid
TXD12925OtherBLUE CROSS AND BLUE SHIELD
TX110902702Medicaid
TXD12925OtherBLUE CROSS AND BLUE SHIELD
TX110902701Medicaid