Provider Demographics
NPI:1710952080
Name:YOUNG, JEFFREY OWEN (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:OWEN
Last Name:YOUNG
Suffix:
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 1:620 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6079
Mailing Address - Country:US
Mailing Address - Phone:303-548-6593
Mailing Address - Fax:
Practice Address - Street 1:1056 S 88TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9460
Practice Address - Country:US
Practice Address - Phone:303-604-0710
Practice Address - Fax:303-604-2995
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1062651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry