Provider Demographics
NPI:1710002399
Name:BIGFORD-YOUNG, MARTHA SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:SUSAN
Last Name:BIGFORD-YOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:SUSAN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1824 LEMAY CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78236-1007
Mailing Address - Country:US
Mailing Address - Phone:210-670-0099
Mailing Address - Fax:
Practice Address - Street 1:1824 LEMAY CIR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-1007
Practice Address - Country:US
Practice Address - Phone:210-670-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0174331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice