Provider Demographics
NPI:1689796856
Name:YOUNG, MARK J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7509 WYNNDEL WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-1092
Mailing Address - Country:US
Mailing Address - Phone:916-801-2677
Mailing Address - Fax:
Practice Address - Street 1:1665 CREEKSIDE DR STE 103
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3538
Practice Address - Country:US
Practice Address - Phone:916-983-7700
Practice Address - Fax:916-983-7981
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217971223E0200X
CA582271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics